Feeding Techniques
Catheters: We have tried a variety of catheters for feeding Cleo. We have settled on the Baird/Davol 94XX series of catheters. These catheters are red rubber with a round tip and two 'eyes'. They are soft and flexible and do not cause a gag reflex when Cleo moves her head while feeding. They may be boiled for re use. Other catheters we have used were stiff making it difficult to safely insert the catheters with out doing damage. With the stiff catheters a move on either mine or Cleo's part that brought pressure on her tongue caused gagging and vomiting.
Catheters are sized by number. Sizes used in feeding Cleo have ranged from #8 to #16. Initially Cleo was fed with a #8 French catheter. She was a large kitten though and the catheters do come is smaller sizes, #4 and #6. As she grew our vet advised us when to increase the catheter size. French catheters do not come in odd sizes so you have to go up 2 digits for each size increase.
The bell end of the catheter fit tightly over the outside hub of a luer lock syringe. So don't cut the bell off the catheters.
If you are reusing the catheters make sure to clean them thoroughly after each use. Flush any formula out and clean the outside with hot water. If you are not sterilizing the catheter right away, place it in clean open container were it can air dry. Do not leave the catheters wet in an air tight container as mold will grow on the inner surfaces. When you boil the catheters make sure they actually boil for 5 minutes. As mineral deposits will build up on the catheters I used distilled water to boil them. I have also boiled them in tap water and when minerals started to build up boiled them a few times in distilled water to help remove the mineral build up. DO NOT try to boil the catheters in a single pan on the stove. They will melt to the bottom of the pan! If you have to use the stove use a double boiler. We used a low sided rectangular plastic Tupperware container and boiled the catheters in the microwave. It is much safer than the double boiler when cats are under foot.
Initially we used paper adhesive tape to mark the catheter at the current length for feeding. As Cleo got older and started to chew through the catheters we switched to cloth tape as it is much tougher to chew through. I have heard of people using paints or white out to mark the catheters. Some of these products are toxic. If in doubt DON'T USE IT. Cleo is a chewer while being fed and I am sure would chew any paint or white out off of the catheter.
As with anything, common sense must prevail in catheter management. Anything used to mark the catheters should be chew proof, secure and non toxic. The catheters should be inspected after every use and discarded if chewed enough to leak or separate. Use only sterilized catheter to feed with. When opening a new catheter inspect it carefully for leaks, bulges and any signs of powders or compounds used in manufacture.
Syringes: Syringes come in several types: We used the Luer lock type as the bell of the catheter fit snugly over the outer shell of the locking hub. We started with 3 CC and migrated to 5, 10, 20, 30 and 60 CC units as the feeding size increased. I would recommend buying in the 3 - 10 - 30 - 60 sequence skipping the 5 and 20 CC units as the feedings grow in size pretty quickly. Buy A GOOD quality syringe As inexpensive units do not move smoothly and the jerking movement of the plunger can cause vomiting or do damage. We use the BD 3096XX series of syringes, they are smooth and easy to regulate the flow of food.
Most good quality syringes can be reused (for feeding) after cleaning and sterilization. We carefully cleaned the syringes after use, removed the plunger so the parts could air dry and stored them in a clean Tupperware container. Covered but NOT airtight so mold can not form. After we collected enough syringes. We boiled the syringes in a plastic tub in the microwave oven. I have heard there is a non toxic sterilizer that can be used to cold sterilize syringes. I was never able to find it so I can not say if it works. After boiling the syringes several times minerals build up on the surfaces. Boil the syringes in distilled water several times to remove the mineral build up. Lubrication that is on the body and rubber plunger is boiled of during sterilization. I used KY jelly to re lubricate these parts.
Tools: Other Items you may need are:
A Small Scale. You will need to keep a record of the kittens weight both for feeding amount adjustment and to check the growth progress of the kitten. A scale that reads in fraction of an Oz. and has good resolution with small amounts of weight is what you need. A bathroom scale does not meet this requirement. What we use is a small Pelouze digital postal scale. It reads to 5 Pounds with good resolution and was not expensive.
An ear bulb syringe. This is a small bulb with a tapered tip. The tip should be soft rubber and not hard plastic. Use the syringe to keep the nostrils clear as cleft palate cats are prone to URI's. Another use for the bulb is to cut of the rounded end of a #8 French catheter. Attach the catheter to the bulb and use it as a vacuum pick. This work great in an older cat when chewed debris gets into the cleft. Squeeze the bulb and place the open end of the catheter onto the debris. Release the bulb and the vacuum will hold the debris on the end of the catheter. It make cleaning out of the cleft area safe with little discomfort to the cat.
A rectal thermometer. URI's are a constant threat when tubing any cat and much more frequent in a cleft cat. Get a good digital thermometer with a soft flexible tip. BE CAREFUL INSERTING any thermometer as cats have fragile rectal tissue. You can also use the thermometer to check the temperature of the formula until you get confident in judging temperature by the 'feel'.
BeniBac or other good bacteria supplement. With the Antibiotic regiment needed to combat the URI's. Cleo was always getting diarrhea from lack of digestive bacteria. Use the bacterial supplement on a regular basis to replace the good bacteria killed off by antibiotic therapy.
Amount To Feed: The amount fed will depend on the brand or recipe that is being fed. Outside of mineral and vitamin content, the unit, Kcal is a measure of energy content for pet food. As a rule of thumb a new born needs a minimum of 85 Kcal per pound per day and this decreases to 35 Kcal per pound per day as an adult cat. Initially we used straight KMR from PetAg which has about .8 Kcal per CC. Cleo weighed 4 Oz at birth and both the math and PetAg's feeding recommendation worked out 30 CC's per day. The rule of thumb is 8 CC's per Oz of body weight per day. Kitten milk substitute is fine for the first 5 or 6 weeks after that you should start weaning to solid foods. This transition has to be done in gradual steps. Cleo was weaned using human baby food. But with the onion powder in baby food controversy I would not do it again. See Cleo's Cookbook on this site for her Sushi milkshake recipe. By starting with small amounts of solids and increasing the proportion of solid kitten food and Nutrical gradually over the next 5 or 6 weeks you can use that formula for weaning. A postal scale can be of help to portion out the food and Nutrical. (By the way Nutrical weighs about 1 gram per CC). As you increase the solids watch the stools, if the become to stiff or hard or stop coming you are going to fast in increasing the solids.
You're veterinarian and the manufacturer of what ever kitten milk replacement product you use can be a great help in determining amount to feed. The manufacturer will have the Kcal level for the food you are using and can help you do or will have already done the math for you.
PetAg's help line # 1 800 323 0877
Feeding Schedule: This can be the roughest part of raising any tube fed new born. Our vet recommended the following schedule: 1st week: every hour, 2nd week every two hours, 3rd week every three hour, 4th week every 4 hours. This was the schedule we followed. PetAg recommends every 3 to 4 hours. In the end the kitten will have the final say as it all depends how much formula you can feed at a time without causing problems. We feed Cleo until her stomach rounded up and we could only get about 1 1/2 CC per feeding into her. This left us feeding her every hour to get her the 30 CCs per day she needed. Take heart though kittens grow fast and stomach capacity will increase. For the Fourth through the Sixth week we stayed at 6 times per day. We were fighting a bad URI at this point and wanted to minimize the chances of vomiting which would only put more nutrients into the culture growing in Cleo's sinuses. After the URI cleared we switched to feeding Four times a day and at 12 weeks dropped the overnight feeding and fed every 8 hours. Today we feed Cleo breakfast around 9AM (90 CC's), Dinner at 5P.M. (90 CC's) and bedtime snack at 11P.M. (60 CC's). This works out to 240 CC's of full strength Sushi milkshake or 240 Kcal per day. At 4.4 Lb. body weight she is getting around 54 Kcal per pound.
Feeding Methods: The first and most important item is keep the feeding low key with a lot of petting, talking, gentle handing and low stress. I you are nervous about doing this don't be. Use care and common sense and it works perfectly every time. If you are feeding a cleft palate cat you are in this for the long run. Most clefts can not be closed before about 8 weeks and 6 Months is more likely. Cleo has a small mouth it has been tube fed for over a year. You need to keep the feeding 'routine' for the cat where he/she expects a meal, companionship and entertainment. If you are tubing from birth the cat will continue to accept the catheter if the remainder of the experience is pleasant. Today Cleo waits on the table at feeding time and will bug us to feed her if we are late. She waits with Maureen at the table while I warm the syringes of food and get the catheter and antibiotics ready. Cleo loves to push Quarter from the table to the floor and watch them roll away. We keep about $20.00 of Cleo's Quarters at the feeding table and these are the entertainment portion of the feeding. Once I arrive with the feeding equipment Cleo becomes all business. She sits in Maureen's hands on a 45 degree angle and waits impatiently for the catheter to be offered. As she is a 'adult' now there is none of this being tubed stuff, she will swallow this catheter on her own thank you. To keep her from getting bored while I feed her I talk to her, sing to her, bite her ears (gently of course) and make funny sounds. She loves this and watches me carefully not to miss something, all the while totally distracted from the tube feeding. This is the relationship you need for long term tube feeding. If you entrust you're baby to another for feeding be sure they carry on the feeding methods you use. Most vet techs look at tube feeding an older cat as an wrestling match. The one time in a year Cleo had to be fed by some one else was when while working on our cattery I nailed three fingers together with a nail gun. We brought her the the vet's to be fed and they pinned her to the table and forced the catheter down her throat. No amount of explanation could change their mind. Bandaged hand or not I fed her every feeding after that.
We prepare Cleo's feeding in advance by mixing and measuring out Two days of feedings in pre filled syringes. As you're life must also continue a 'system' for feeding should be foremost on you're mind. For us we use the pre filled syringes and pre marked catheters. With everything I use organized in one cabinet by the sink we can feed Cleo start to finish in about 20 minutes. I use the microwave to heat the syringes and our 900 watt oven on Hi heats 60 CC syringes to just below cat body temperature in 16 seconds, the 30 CC syringes take 10 seconds. This is the Sushi Milkshake of course. After heating I agitate the syringes for 10 to 15 seconds to even the temperature and mix the contents that have settled. I always check the temperature of the formula before feeding. As my hands are not as sensitive and perception of temperature is relative to the environment anyway. I used the thermometer and now have the feel so I drop the formula on my inner lip area to check. I found with Cleo too warm brought on vomiting and too cold would cause shivering. I kept the temperature around 90 degrees.
We feed Cleo with her sitting on a towel and her front paws resting in Maureen's hands. Her body is on about a 45 Degree angle. This angle works well as it is comfortable for Cleo and as the formula is introduced it collects in the bottom of the stomach and trapped air can still exit around the catheter without causing vomiting. While on the subject of vomiting you must be extremely careful not to allow the cat to aspirate any vomit or food collected in the mouth. Aspiration of food is usually fatal in small cats. When Cleo vomited we immediately turned her bottom side up to force the fluids to drain away from her airway. I used the bulb syringe to suction out the mouth and nostrils. And when we were sure she would not aspirate returned her to her feet.
If you do not own one get a stethoscope. Listen to the cat's lungs and become familiar with the various sounds a normal cleft palate cat makes. After a rough feeding during which she vomited I always listened to Cleo to be her lung fields were clear.
We regularly checked the tape marks used to determine the length to place the catheter into Cleo. The proper insertion length is measured from the front teeth to the back of the rib cage with the cat standing. I checked this every few days as kittens grow fast.
To get used to the amount of pressure needed move the formula through the catheter and overcome the friction of the syringe I emptied several syringes of KMR, new formula and every time we changed catheter size to become used to what I should feel during feeding. It is important not to pressurized the cats stomach as it can burst in severe cases but more likely will empty itself through vomiting. Prior to feeding feel the cats stomach and get a starting point for the feeding. The object is to feed until the belly rounds up slightly or the allocated amount has been fed. Be careful not to over feed as again it will cause vomiting.
As small cats are sensitive to contaminates and have immature immune systems, I always scrub before feeding Cleo. This provides a good barrier between handling our other cats and what I directly introduced into her. I use Hibiclens surgical scrub to clean with. I also use it now to prevent spreading problems amongst our cat population while treating or medicating sick animals. A quick wash after can save you a lot of aggravation later.
Once I am ready to feed Cleo I attach the catheter to the syringe and flush the air from the catheter by passing some formula into a waste container. I clean off any formula from the tip to avoid passing it through the cleft into the sinus while inserting the tube. And then lubricate the catheter with a very thin film of KY jelly. DO NOT USE VASELINE! Prior to tubing Cleo I would observe her breathing rate for comparison after she was tubed. Before Cleo started tubing herself I would hold her mouth open with my left hand and place the catheter over her tongue starting on a slight angle from the Left. The catheter would travel back against the roof of the mouth and I would slowly advance it till I felt it pass into the esophagus. Then slowly advance the catheter till I reached the tape mark. While inserting the catheter I watched Cleo for any signs of panic or discomfort. And of course the catheter should pass into the stomach without much if any resistance. The tube should go in to the length set by the tape mark. If not you may be in the lungs which is a shorter path than the stomach. If this happens start over. Once tubed I would check Cleo breathing and compare my observation to what I had observed prior to inserting the catheter and listen for any odd sound she might make. Our vet told me to draw back slightly on the syringe and if I met little resistance I was mostly likely in the lungs and sucking air. Once I was ready I would introduce a little formula again observing Cleo breathing and demeanor. If everything looked OK I would feed her by SLOWLY depressing the syringe. When we were feeding small amounts I would feed a .1 of a CC about every 2 to 3 seconds. As the feeding size grew I increased the amount to .5 CC and finally 1 CC for every 2 to 4 seconds. Either Maureen or I would monitor Cleo's stomach and when her belly began to round up we would stop feeding. Once the feeding became larger I would give Cleo's stomach an expansion break by feeding about 50% and stop for the number of seconds equal to the number of CC's given. And repeat this till the formula was introduced or the stomach filled up. The expansion break almost completely eliminated vomiting and hiccups during or after feeding. Once the feeding is complete remove the catheter slowly, no real resistance should be felt during removal. We always observe Cleo for about 5 minutes after feeding for anything unusual. We use this time for petting or playing with the Quarters and is an expected part of the routine now.
Our check list looks like this:
Temperature OK?
Baseline breathing and stomach size.
Expel air from the catheter.
Noises during or after insertion, observe breathing.
Tube in completely?
Breathing OK?
Introduce a small amount of formula check breathing.