The most frequent gastrointestinal complications associated with tube-feeding are vomiting and diarrhea. Vomiting usually results from overaggressive feeding. Decreased volume and slower administration of food should correct the problem. Although underlying disease is the most common cause of diarrhea in tube-fed animals, begin feeding gradually to avoid the potential for dietary causes of diarrhea. Adding fiber may be helpful, but may not be possible with small-bore feeding tubes.

Mechanical complications include tube migration and removal or obstruction. Proper maintenance of the tube helps preclude many of these complications. Avoid the use of snug sutures or skin glue. Flush the tube with water before and after every feeding. If a tube becomes occluded, vigorously flush the tube with air or water, infuse carbonated beverages, or instill pancreatic enzymes.

Metabolic complications are sometimes seen in patients. Hypophosphatemia results from a shift from catabolism to anabolism. Arginine deficiency has been reported in cats fed human and veterinary milk-based diets. Diabetics and glucose-intolerant animals should be fed high-fat, low carbohydrate (meat-based vs. milk based) diets.

Enteral diets should be stored properly to avoid bacterial contamination. Infusing a diet over a period of 12 to 24 hours increases the chance of bacterial proliferation. Microbiologic complications can also occur at the catheter site. Tubes should be left in place for at least 7 days to avoid peritonitis.

Aspiration is another complication that can be avoided with proper tube placement. Animals with dysphagia or impaired swallowing reflexes should have a gastrostomy or enterostomy tube placed.

COMMENTARY: This paper covers some of the basic tips to remember when using enteral feeding, including tips for placing the tubes. Malnutrition is a major consequence in sick or injured patients. Providing proper nutrition through tube-feeding can help decrease the compromise of decreased nutrition which includes decreased immunocompetence and decreased tissue synthesis and repair.

Complications of enteral feeding: how to recognize and avoid them. Davenport DJ. ACVIM PROCEEDINGS, 2003, pp 626-628.