Feeding tube

A feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by swallowing. The state of being fed by a feeding tube is called enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. A variety of feeding tubes are used in medical practice. They are usually made of polyurethane or silicone. The diameter of a feeding tube is measured in French units (each French unit equals 0.33 millimeters). They are classified by site of insertion and intended use.

Types of feeding tubes

Nasogastric

A nasogastric feeding tube, or "NG-tube", is passed through the nares, down the esophagus and into the stomach.

Gastric feeding tube

A gastric feeding tube (or "G-tube," or "button") is a tube inserted through a small incision in the abdomen into the stomach and is used for long-term enteral nutrition. The most common type is the percutaneous endoscopic gastrostomy (PEG) tube. It is placed endoscopically: the patient is sedated, and an endoscope is passed through the mouth and esophagus into the stomach. The position of the endoscope can be visualized on the outside of the patient's abdomen because it contains a powerful light source. A needle is inserted through the abdomen, visualized within the stomach by the endoscope, and a suture passed through the needle is grasped by the endoscope and pulled up through the esophagus. The suture is then tied to the end of the PEG tube that will be external, and pulled back down through the esophagus, stomach, and out through the abdominal wall. The insertion takes about 20 minutes. The tube is kept within the stomach either by a balloon on its tip (which can be deflated) or by a retention dome which is wider than the tract of the tube.

Gastric tubes are suitable for long-term use; they last about six months, and can be replaced through an existing passage without an additional endoscopic procedure. The G-tube is useful where there is difficulty with swallowing because of neurologic or anatomic disorders (stroke, esophageal atresia, tracheoesophageal fistula), and to avoid the risk of aspiration pneumonia. It is also used when patients are malnourished and cannot take enough food by mouth to maintain their weight, such as with mitochondrial disease.

Effectiveness

A feeding tube can be used for bolus or continual feedings.

A feeding tube is very effective when initially placed properly by a trained physician.

Depending on the type of feeding tube placed, it is quite possible to learn to replace the tube yourself. Surgery is normally not required to replace the tube.

Feeding tubes have a tendency to become clogged or occluded. This can lead to the need for replacement of the tube. Feeding tube clogging can be time consuming, and can prevent nutritional supplementation when clogged and awaiting declogging or replacement.

Withdrawal

Tube feeding, like all medical treatments, can be declined or withdrawn, especially in the setting of a terminal illness where its use would not alter the ultimate outcome. Alternatively, nutrition can be withheld and the tube used only for hydration and medicine.

It should be noted the patient may become used to feeding via tube, when attempting to switch to regular feedings may be difficult.

Rejection

Tube feeding may be rejected by patients when first administered. It can be difficult for some patients to tolerate due to nausea. Delivery method, frequency of feedings and formula compositions can be altered, or changed to increase chances for patient tolerance.

See also

• Bioethics
• Saline flush
• Force-feeding for tube feeding against an individual's will or as torture

External links

• Oley Foundation for people who feed by tube or IV at home
• Oral Cancer Foundation
• Children's G-tube Book
• Pediatric Tube Feeding