What are Techniques for tube feeding?

Answer 1

The three most common ways to be tube fed are either through a tube through the nose called a Nasogastric or Nasoenteric tube (NG or NE Tube), a Gastric Tube (G-Tube) or a jejunostomy tube (J-Tube). Sometimes the G and J can be combined into a G-J Tube.

The NG Tube is intended for short term use, less than 3 months and typically the end of the tube will end in the stomach. Lengths are range around 1 to 4 feet, appropriate lengthy is determined based on the distance from nose to stomach on the patient.

The G-Tube is placed through the side of the stomach and ends in the stomach. This is intended for longer term use. A standard G-Tube length is around 9 inches with around 6 inches above the skin surface, however some manufactures make low profile devices that require the addition of an extension tube when it is time for a feeding. These devices require a measurement be made for determining proper tube length for the semi-permanent device. Extension tubes to connect to the device are usually around 6 - 12 inches and are disposable.

J-tubes will also go through the abdomen area where the tube will end in the Jejunum (small intestine). This is also a long term choice. Patients with a J-tube typically do not have a properly functioning stomach. Most nutrition absorption actually takes place in the Jejunum with the stomach being more of a tool for breaking down the food so that it can be absorbed. Doctors prefer to use the stomach if it is functioning.

A G-J Tube will have a portion of the tube with an opening to the stomach and at the end in the Jejunum. This would typically be used on a patient with a partially working stomach or with a patient whose stomach has atrophied and the doctor is working on a program to rehabilitate.

In all four cases liquid nutrition is delivered through the tube. Usually referred to as formula.

Formula is chosen by a dietitian based on the patients condition, nutritional needs, and position of the tube. Although rare, some patients may have a fully functioning gastric system but if they have a condition that affects their ability to take in the right nutrients they need a formula supplement. In these cases the patient if physically able to drink their nutrition. However, unlike supplements like Ensure that are very nutritious and flavored nicely, some specialty formulas are not and can be unpalatable. In these cases the patient may eat normally and have a G-Tube for getting the formula. This is commonly seen with children with extreme food Allergies.

Patients may be on intermittent feedings or continuous feedings.

An intermittent feeding is most similar to eating a periodic meal. It would be like receiving a dose, then waiting a certain number of hours and taking another dose. Common methods of delivery for an intermittent dose may be to fill a large syringe or container hooked up to the tube and just letting it drain in over a short period of time. This is called bolus or gravity feeding. Or if the feeding is going to take longer than 30 minutes the patient may find it more beneficial to use a pump that can control the rate of delivery and allow the patient or caregiver the opportunity to be doing other things during the delivery.

Continuous feedings are just that, continuous over long periods of time. Not typically over 24 hours, but 18 or 20 hours are not uncommon. Continuous feedings almost always require a pump. Especially if the patient is able to be to get around on their own, are active, or have an active caregiver. Continuous feedings are common in children with metabolic disorders that need a constant drip to maintain sugar levels. These children may be otherwise healthy.

Continuous feedings that do not require a pump are patients that are not active, are bed ridden, possibly in a nursing facility. These patients can receive their nutrition by gravity and a roller clamp on the delivery tube can be adjusted to control the rate.

Feeding pumps come in a variety of sizes. As small enough to fit in your hand and carry around in a small discrete pack called an ambulatory pump, or around 12 X 9 X 6 block that is mostly used attached to an IV pole and called a stationary pump.