How can milk get into the airway? What can go wrong?
Always remember the three key points to ensure safe tube feeding: 1) Pass the tube gently, this means the tube will safely and easily pass into the oesophagus, not the airway 2) Pass the tube far enough so the tip is positioned well beyond the airway entrance, ensure it stays there throughout fluid flow 3) Ensure the calf’s head AND neck remain above stomach level throughout feeding.
For a calf to get milk on the lungs, milk needs to enter the trachea or windpipe. The entrance to the windpipe is within the throat, just underneath the path of the tube into the oesophagus. Provided the tube is passed a safe distance beyond the entrance and the liquid can flow freely down the oesophagus to the stomachs, your calf will be safe. Here are the possible reasons fluid could enter the airway:
- The tube is not passed far enough beyond the windpipe/airway opening – Antahi tubers provide a size markings to indicate when you have reached the safe zone. If in doubt, pass the tube further, always use the size guides as a minimum.
- The tube comes out of the oesophagus during flow – ensure the tube is not pulled out.
- The head OR neck is lower than the stomach resulting in gravity back flow. Remember the oesophagus sit very low in the neck so it is essential the lower neck is higher than the stomach.
- The tube is pulled out too early – wait until all liquid has exited the tube and passed down the oesophagus before removing.
- The calf is overfed resulting in overflow of fluid from the stomach and up the oesophagus – monitor your calf throughout feeding to ensure any discomfort, bloating, or change in behaviour is noticed. If your calf becomes uncomfortably full then stop flow by lowering the bottle.
- The calf is sick and the stomach is not working properly resulting in backflow of fluid up the oesophagus.
- The tube has entered the airway – see note.
- The tube is punctured or damaged resulting in fluid leaking behind the tube tip.
If at any point you suspect something is wrong, immediately lower the bottle to stop fluid flow. Split feeds into smaller volumes if uncertain about how much liquid the calf has already consumed.
Note: It is much more difficult for the tube to enter the airway rather than follow the path of least resistance into the oesophagus, however it pays to double check the tube position by looking for the tube tip movement in the groove of the left neck. To reduce the chances of the tube entering the airway take these precautions:
- Handle the calf gently and pass the tube gently. The calf will swallow easily when it is comfortable. Do not turn the calf’s nose up of force the tube downward when passing the tube, this creates a more direct line toward the airway. Remember the oesophagus is ABOVE the airway (and slightly to the left) so imagine the tube needing to curve over the airway entrance NOT down.
- Pre-soften the tube in very cold weather, this will help the tube flex around the airway.
- If you feel resistance when passing the tube, withdraw the tube, direct the tube tip to the left side of the throat, ensure the calf is comfortable, and repass the tube (do not force). Entering the airway requires force – despite what some people say, feeling a ‘pop’ is not a good indication of appropriate tube placement as a) this could be confused with airway entry or b) you are damaging delicate tissue surrounding the airway.
- Double check tube position. Learn to look or feel for the tube in the oesophagus in the left neck groove.
We understand some calves wriggle more than others. When you have a wriggly calf it is recommended that you wait for a few moments for the calf to settle, rather than tube feeding a highly stressed animal. Check the calf position – is it comfortable? Are you using a back stop or corner of the pen to relax the calf and reduce necessary head restraint? If the calf has moved from a standing to a sitting position this is fine provided the calf is still comfortable. Check the tube position in the oesophagus. Check the tube has not pulled out of position. Pass the tube further down to increase wiggle room (consider the size markers a minimum, you are safe to pass the tube further without causing damage). Then allow the liquid to flow.
Please see our calf handling tips and read our safe-use guide to help optimise the experience for both you and your calf. We have a great anatomy video available on our videos page.