It is not difficult to learn the correct tube feeding procedure. Purchase the tube feeder through your veterinarian, who will be able to equip you with the correct diameter catheter and syringe size for your Shih Tzu. Sterilize both catheter and syringe between early feedings. The syringe will have graduated markings on the side to record accurate intake. You will need a bowl or large measuring cup for warm water, a candy thermometer and a nontoxic indelible pen or dull knife.

1. Place water heated to 100 degrees Fahrenheit in the bowl or measuring cup.
2. Heat the formula separately (also to 100 degrees Fahrenheit) using the candy thermometer to regulate the temperatures of both liquids.
3. Put the thermometer, syringe, catheter and warmed formula into the bowl of water for transport to the Shih Tzu puppy.

Each puppy should be measured for gavage feeding. Correct measurement is crucial to the Shih Tzu puppys well-being.

1. Lay each puppy flat on it side on a towel.
2. Measure the catheter from the rounded tip held at a point just behind the Shih Tzu puppys last rib, along the side of the chest and throat, to just in front of the Shih Tzu puppys muzzle.
3. Mark the spot of the Shih Tzu puppys muzzle on the catheter with the pen or dull knife.

If you get the catheter too short, the formula may be aspirated by the Shih Tzu puppy. If you introduce a catheter too long it can puncture through the newborn Shih Tzus delicate stomach wall. Have your vet walk you through the procedure.

If the end of the catheter is too wide to allow attachment to the syringe, sever the catheter directly behind the beginning of the flute to allow secure attachment to the syringe. Now that you have the syringe attached, place the catheter end into the warmed formula and withdraw the syringe from the plunger. Fill the syringe a few milliliters over the amount directed by your vet. Keep the catheter tip pointed downward, preventing air from getting in.

1. Place the Shih Tzu puppy on a towel in your lap, head elevated in a slightly inclined position. Wrap one hand around the back of the Shih Tzu puppys head, palm against the back of the skull.
2. Stroke the Shih Tzu puppy with your thumb and opposing fingers on each side of the muzzle by the lip corners. The Shih Tzu puppy should respond by opening its mouth.
3. Always keep the syringe elevated and the catheter end pointing downward.
4. You want very small amounts of formula to slowly drip from the catheters tip, preventing air from getting in.
5. Directly and gently introduce the tube through the front of the Shih Tzu puppys mouth. Never force a catheter down a Shih Tzu puppys throat. Never insert at an angle.
6. The Shih Tzu puppy may at first struggle at the catheters introduction. Do not push if the catheter does not slip easily down the esophagus. Withdraw the catheter and try again. If the Shih Tzu puppy struggles against the introduction of the catheter, gently apply a small amount of steady pressure to the catheter against the Shih Tzu puppys resistance; the Shih Tzu puppy should reflexively swallow. The passage should suddenly open and the tube should slide down easily.
7. The catheter is in correct position when the mark you made is just slightly beyond the tip of the Shih Tzu puppys muzzle.
8. Slowly depress the syringe plunger to begin feeding.
9. Never feed a Shih Tzu puppy until its abdomen is distended and hard. If the Shih Tzu puppys stomach remains flaccid, you have not fed enough. Feed half the formula, and then burp the Shih Tzu puppy.
10. Be sure to have your vet walk you through the correct procedure for tube feeding before you try this yourself.