Tube Feedings

Definition

Tube feeding is a procedure used for placing food, fluids, and drugs directly into the stomach or small intestine through a tube inserted through the nose or abdomen. Tube feeding is also called enteral feeding or enteral nutrition.

Purpose

Tube feeding is used with people who have normally functioning digestive systems, but who cannot or will not take food by mouth. Common reasons to perform tube feeding include:

• stroke resulting in paralysis of the muscles involved in swallowing
• coma
• cancer of the mouth, throat, or esophagus
• trauma or burns to the mouth, throat, or esophagus
• mental illness such as anorexia or dementia that leads to refusal to eat

Most often people are fed through a nasogastric tube that goes from the nose through the esophagus and into the stomach. This method of tube feeding is preferred for short term feeding problems that do not last longer than about two weeks. There are two choices for tube feeding that is needed on a long term basis. One is the insertion of a nasointestinal tube that passes through the stomach and delivers nutrients directly into the small intestine. A nasointestinal tube is also used after gastric surgery, gastric trauma, or paralysis of the stomach muscles. The other option for long term feeding lasting over 30 days is a tube that is surgically placed through the abdomen directly into the small intestine. This is called a percutaneous endoscopic gastrostomy (PEG) tube. PEG tubes are often used for individuals with oral cancer as well as for elderly patients who cannot physically pass food through the mouth.

Precautions

Problems can arise in the insertion of the tube. During the actual feeding process, care must be taken to introduce the food at a manageable rate. Also, the tube must be kept clean and flushed after each use.

Description

Tube feedings can be delivered either continuously or intermittently by gravity feed or by pump. Each method has its advantages and disadvantages. The critically ill are often put on continuous feed systems. Each institution has a protocol for starting an individual on tube feedings that specifies the initial rate of flow. A nutritionist works with the physician to determine the appropriate caloric, water, and micronutrient needs of each individual. Medications can be added to the food if necessary.

In individuals needing long-term tube feeding, a PEG tube is placed through the abdominal wall during a simple surgery that lasts about 20 minutes. The tube has a valve that closes the end outside the body. When the tube is taped to the patient's stomach, it is not particularly noticeable under street clothes. Many patients with PEG tubes, or their caregivers, learn how to care for the tube and feed themselves at home. The feeding tube must be replaced about every six months.

Preparation

A nutritionist should evaluate the individual's nutrient needs before tube feeding begins. Special tube feeding diets exist for a variety of conditions such as kidney failure, liver failure, trauma, glucose intolerance, and other special needs.

Aftercare

Cleaning and maintaining the tube and feeding equipment are necessary after each use. Once the tube is removed, little aftercare is needed. After tube removal, individuals with PEG tubes will need to keep the tube site clean and covered until it heals.

Complications

Tube feeding is a relatively safe procedure. The most serious complications that occur when using a nasogastric tube involve aspiration of the nutrients. Other complications from all tube feeding can include diarrhea, changes in the absorption rate of drugs, and metabolic (fluid and electrolyte) disturbances related to the composition of the food. Many of these complications can be reduced or eliminated by working closely with a nutritionist who has expertise in tube feeding.

Results

Tube feeding is an effective way to provide nutrients, fluids, and drugs to patients who cannot take these things by mouth. The ultimate health of the patient depends largely on the reason the feeding tube was needed.

Health care team roles

A nutritionist is a key person on the health care team when caring for someone who is being tube fed. The nutritionist makes an initial needs assessment and helps the physician decide on an appropriate feeding program. Once tube feeding has begun, the nutritionist assess the results and makes recommendations to help control complications such as diarrhea. Besides the physician, other health care workers who may be involved in the care of a person being tube fed include a dietitian, nurses, and a pharmacist experienced in changes in drug metabolism caused by tube feeding. If the individual is going to be tube fed at home, a nurse will educate the patient and caregiver about tube care and feeding. A visiting nurse may follow up with a patient being tube fed at home.

KEY TERMS

Aspirate— To breathe foreign material into the lungs, as when stomach contents back up into the mouth and are breathed into the windpipe.

Resources

BOOKS

Nuzum, Robert. "Gastrointestinal Intubation." In Manual of Gastroenterologic Procedure, edited by D. Drossman New York: Raven Press, 1993.

ORGANIZATIONS

American Gastroenterological Association. 4930 Del Ray Avenue Bethesda, MD 20814 (301) 654-5920. 〈http://www.gastro.org〉.

OTHER

Dharmarajan, T.S. and D. Unnikrishnan. "Tube Feeding in the Elderly." Postgraduate Medicine Online. 115 (February 2004) http://www.postgradmed.com/issues/2004/02_04/dharmajan.htm (November 23, 2005).

"Nutritional Support." The Merck Manual of Diagnosis and Therapy. 1995–2005, Section 1, Chapter 1 http://www.merck.com/mrkshared/mmanual/section1/chapter1/1c.jsp (November 23, 2005).

Oral Cancer Foundation. "Feeding Tubes." undated http://www.oralcancerfoundation.org/dental/tube_feeding.htm (November 23, 2005).

University of Pittsburgh Medical Center. "Home Nasogastric Tube Feeding." 2003 http://patienteducation.upmc.com/Pdf/NasogasTubeFeed.pdf (November 23, 2005).