Problem With E-tube, Please Help!

littlecaitling

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Hello! I've read these forums for awhile now, but finally found myself needing to make a post of my own. My 14 year old boy named Dusty had an E-tube placed this afternoon. He wasn't feeling great before, but his lethargy since coming home has been concerning for me. He just lays in the same spot on my bed, barely moving and not purring when I pet him, which is so unlike him even when he's ill. The techs said that he was energetic after coming out of anesethia and was his usual wiggle-worm self when they gave his first feed, but by the time I came to get him he was a lump in the corner of the kennel! I know he was under general anesthesia, but that was almost 12 hours ago by now and he was perkier at the vet before the first feed. How concerned should I be?

But more importantly, I can't seem to figure out how to remove the cap from his tube! The tech showed me how to do this when I picked him up but between sleep deprivation and general overwhelm over the situation I'm ashamed to admit I don't remember seeing how he removed the cap. I've attached a few pictures in case someone could possibly explain this to me.

My plan is to wait until morning and arrive at the vet when they open (approx 10 hours from now), but in the meantime I can't get any food or medications in him. He has even less interest in food than before the tube was placed, and he has gagged a few times since coming home so I'd like to avoid forcing food or meds orally. After all, that's why he got the tube in the first place!

Any advice would be greatly appreciated. Aren't these tubes supposed to be well tolerated? Is the situation emergent enough that I should find a 24 hour hospital now before the regular vet opens in the morning? How do I remove the blasted cap from this thing!? It breaks my heart to see my little love bug like this!
 

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stephanietx

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I am no help, but have you tried looking for a YouTube video or googling it to find a graphic?
 

daftcat75

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Doesn't the cap just unscrew off? Holding the tube in one hand so as not to yank on it and unscrewing from the bottom of the cap? I think there's another piece that's wedged inside the tube that the cap is screwing onto.

His first feed, what was it? Also, what is the condition that has caused his inappetance? Also, bless you for getting him the assistance he needs right now. A lot of guardians shy away from the feeding tube and suffer needlessly with the cat trying to make force feeding work.

That out of the way, it's possible that whatever the vet office fed him by tube was too much food for him depending on how long it's been since he ate or it didn't agree with him. Or if he has pancreatitis, then anything that triggers the release of digestive enzymes can potentially cause him to do the lethargic, nose-down crouch of a cat in pain.

If you do want to feed him and you figure out how to get the cap off, make sure you warm up the food to room temperature or even luke warm by submerging the syringes in hot water for a few minutes. But you also don't want it to be too hot. Go very slow. And only give a few cc tonight. I would do maybe 2 or 3 cc lukewarm water flush, then 2 or 3 cc food (make sure it's thin enough that you don't pop it in him too fast), and then another 2 or 3 cc lukewarm water flush to finish before capping. Consider it a practice run.

Finally, check out Kitty Kollar-Special Hugs for special kitties (Kanine Kollars too) for a protective collar that makes it easier to change the stoma site bandages. They also sell caps and syringes and have other tips about e-tubes.
 

daftcat75

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I don't know how Krista tolerated the tube in the first 12-24 hours because she was hospitalized during that time. She had dental surgery and an ear infection that turned into a perforated eardrum. It was still several days after she got the tube that I was finally able to take her home. But she seemed to tolerate the tube very well except when I fed her too fast or too cold. Otherwise, she seemed to understand what it meant when the syringes came out and was mostly mellow and chill until we were done (or until she thought we were done and I would gently squish her back down for the next syringe.)
 

daftcat75

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When you take him back in, have the vet mark the skin line on the tube with a Sharpie. This way if the tube is moving around (dipping too low or coming out of him), you can see that when you clean the stoma site. Krista's tube was not quite long enough for the Kitty Kollar. So when it did lay flat into the Kitty Kollar after a site cleaning, that was when I started to realize the tube was coming out. As long as it doesn't come out completely, the vet can easily re-adjust it and re-do the sutures.
 
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littlecaitling

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Dusty has been a megacolon kitty for probably 10 years now, for the most part successfully managed with various canned diets and laxatives (lactulose then miralax), eventually adding cisapride for motility. He lost his brother Jack after a short fight with lymphoma and a few weeks after that we were in for a bout of constipation and the vet found a mass in his rectum. So we assumed intestinal lymphoma and started prednisolone + chlorambucil immediately. That was a year and a half ago; he responded very well to the treatment and has had no real complications until the past two weeks where my usually piggy boy would have on and off issues with appetite. The vet has done bloodwork, x-rays, palpated his abdomen, everything was normal and unchanged so it's not clear yet why he's suddenly gone hyporexic. No signs of hepatic lipidosis, kidney failure, or pancreatitis. He lost about 1/4lb in two weeks though so I knew it was time to get aggressive about calorie intake.

They sent me home with a case of purina critical nutrition. I blend it 1:1 with warm water and for the first day was to feed ~40ml 5 times. The first 40ml was done in the hospital as a demo and to make sure he would tolerate the feedings.

I also crushed up his solid meds (prednisolone, omeprazole as needed), mixed with liquid meds (cisapride, simethicone) with some water and miralax to be syringed following the first water flush. It was so frustrating to have everything set up only to find myself unable to remove the cap!

It should screw off, I remember all the connections being luer locked. They gave me an extension set (like used for IV lines) to connect between the tube and syringes, but I just can't seem to unscrew the cap on the tube! I agree that it looks wedged in there somehow, but the lighter green piece doesn't seem to come off the darker green piece and I'm nervous about just yanking the whole apparatus out of the rubber tube. I don't want to break it! Also when I fidget enough with the end of the tube I can tell it bothers him, poor thing.

I just wanted to give Dusty the best chance at feeling better and having more quality time with us, so I opted for the e-tube. But now it feels like that's backfired spectacularly! He seems more miserable than I've ever seen him before and I feel helpless to relieve his discomfort.
 
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littlecaitling

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I am so sorry, I forgot to thank you for taking the time to reply! I'm so panicked and worried over my sweet boy, it really means so much that you offered so much info and advice so quickly. It was sorely needed, and is greatly appreciated. Thank you
 

tangers40

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It doesn't look to me like the smaller green piece is luer-locked onto anything there, so it may just pull off. I can see the luer-lock threads where the larger green piece is attached to the tube, but nothing up above. If it does just pull off, perhaps it had some food or something dry onto it and it's just stuck?
 

daftcat75

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To be honest, I never used the tube for a full feeding with Krista. By the time I took her home from the hospital, she was already eating on her own again. At that point, I kept the tube for meds and in case she back-slid and stopped eating again. Ultimately, she ended up yanking it out herself at the vet's office. They were re-adjusting it because the sutures came undone again. There was still one in her neck that they were trying to attach to and she jerked away at the worst time leaving the vet with a tube in her hand that no longer entered Krista's neck. Krista's like that. She gets pushy at the vet's office and directs her own care. She usually gets herself sedated for same-day dentals because there isn't anything else they can do with her when she gets like that.

The feeding tube seems like a lot to handle now. You'll get the hang of it and Dusty will appreciate it too. It's good to take him back in. The tube may have dipped too low causing him discomfort. Or 40 cc could be a large meal for him depending on how much he usually eats and the last time he ate that much. The vet will definitely be able to offer better guidance and diagnostics than myself.
 

daftcat75

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It looks like the light green piece is a distraction and probably doesn't come off. The darker piece has threads at the bottom. I believe there is a luer lock end that is wedged into the tube and the darker green piece is screwing onto that. Hold the tube in place with one hand so you're not yanking on it, and unscrew from the bottom of the darker green piece.
 

di and bob

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Very important to flush the inside of teh tube with water when done with every feeding. Food dries inside and it won't work. Every one is different. does yoru vet have an answering service to get hold of?
It is not unusual for a cat to take one or two days to fully recover from anesthesia. I had one that didn't eat, didn't move for almost three. This is all new right now and scary, you and he will adjust in time. All the luck!
 

LTS3

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Very important to flush the inside of teh tube with water when done with every feeding.
What kind of water? Tap water? Bottled water? Sterile water?

From the picture, it looks like the light green part can be pulled off from the darker green part. Give that a try gently.
 
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littlecaitling

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Really, I cannot thank you all enough for your concern, support, and advice! While I'm not entirely unfamiliar with e-tubes in cats, this is my first time with one in *my* kitty and I think I'm handling it worse than he is honestly! I don't really have local support right now so truly the impact of everyone's kindness here cannot be understated.

Our usual cat clinic is closed today, but I managed to get in to a different location of the same practice pretty early this morning. Another vet who is familiar with Dusty saw him and, thank the Lord, she managed to remove the cap! The technician must have really jammed it in there, and I was being way too timid about pulling it out (wasn't a luer lock after all, although the threading on both the cap and extension set threw me off).

The change of scenery must have really perked him up, and while he still looks pretty bad he was back to his usual escape artist self at the vet. Unfortunately he has dramatically lost weight since two days ago (nearly half a lb, though there is always some variation between scales). But now that I'm able to use the tube correctly I'm hopeful that I can correct it in time.

I was also able to see his xray confirming placement from yesterday, and I noticed how full his stomach was with food. No wonder he seemed so uncomfortable after his first tube feeding! While he has used the litter box a few times since tube placement, I can tell that he is a bit constipated so I will be careful not to overdo it with the feedings and stop if I notice any signs of nausea. After returning home he has so far received the medications he missed last night, as well as a generous dose of miralax to soften things up and hopefully get things moving.

I'm giving him a bit of time to relax and the food some time to warm up before proceeding with the feeding. Since he's moving about and asked nicely I'm sitting with him on the back porch. They're usually strictly indoor only cats but I found with his brother as well that a little bit of sunshine and fresh air can be the best medicine when they're feeling especially low.

We're clearly not out of the woods yet, but he's already looking so much better than just last night so finally I'm feeling hopeful that this e-tube will be able to help me accomplish what I needed it to; a better nourished cat with a change at maintaining a quality of life for awhile longer.
 

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littlecaitling

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What kind of water? Tap water? Bottled water? Sterile water?
The discharge instructions said tap water was fine, but since I leave out filtered water for the cats to drink I figure I would use the same for the tube. I definitely flush before and after each feeding and medication, a little more than 5ml since there's a lot of dead volume in the extension tubing I connect to the syringes. I really like using the extension set though! I can see the line being cleared and it gives the cat more leeway to move around without pulling on the tube.
 

stephanietx

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I am glad you are less stressed and he seems to be more relaxed and doing okay. So glad you got him into a vet and got the help you needed. Hope he continues to improve, gain weight, and do well.
 

di and bob

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Tap water is fine as long as it is clean. It is going into the stomach. To be safe, we alaways used sterile water, but that was in humans. To cut down teh expense, you could alwasy boil it for a minute or two and let it cool.
 
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