tube feeding

tube feeding, method of delivering nutrients directly into the stomach or small intestine through a flexible tube. Tube feeding is commonly used for patients who are comatose, are undernourished or have a severely decreased appetite, or are affected by an injury, disorder, or illness that renders them unable to swallow or eat by mouth. Tube feeding can be temporary or long term, depending on the individual’s needs.

Tube placement

The method of tube placement depends on the duration of feeding and the patient’s condition. For short-term feeding, a nasogastric (NG) tube, inserted through the nose and into the stomach, or a nasoenteric tube, inserted through the nose and into the small intestine, may be used. Placement of these tubes typically is performed at the bedside, without the need for special imaging or procedures, and is confirmed by X-ray or pH testing of gastric contents.

For long-term feeding, a gastrostomy tube (G-tube) or jejunostomy tube (J-tube) may be surgically inserted through the abdominal wall and into the stomach or jejunum (the middle segment of the small intestine), respectively. Placement may be performed surgically or via a minimally invasive endoscopic procedure known as percutaneous endoscopic gastrostomy (PEG). Proper placement is essential and must be verified before feeding begins.

Formulas and delivery techniques

Tube-feeding formulas typically contain a mix of carbohydrates, proteins, fats, vitamins, and minerals often tailored to meet the patient’s calorie and nutrient needs. Examples of formulas include standard formulas, which are suitable for individuals with healthy digestive tracts and which meet the nutritional needs of most patients; high-protein or high-calorie formulas for individuals with increased nutritional needs; and disease-specific formulas, which are tailored for patients with such conditions as diabetes or kidney disease. Some formulas are fiber enriched for digestive health, whereas others are elemental (partially digested) for easier absorption.

Tube-feeding formulas can be delivered using several techniques. The method chosen depends on the patient’s tolerance, mobility, and nutritional needs. In bolus feeding, for example, relatively large amounts of formula are administered over a short period, mimicking meals. The formula is usually delivered with a syringe or by gravity, in which the formula bag is hung on a pole above the height of the patient and formula flows down into the feeding tube, with the flow rate controlled by a roller clamp on the tube connected to the bag. Intermittent feeding is spread out over longer periods, with multiple sessions a day. In this method formula administration is regulated via a gravity drip, pump, or syringe. Continuous feeding uses a pump to deliver formula slowly over many hours. This approach is often used for patients who are critically ill, have digestive issues, or are at risk of aspiration. Cyclic feeding is a type of continuous feeding that is performed during a set time each day, such as overnight.

Benefits and complications

Tube feeding is generally safe and beneficial for patients. In particular, it plays a crucial role in helping to prevent malnutrition and dehydration. Proper nutrition through tube feeding can also facilitate recovery after illness, injury, or surgery and improve patient quality of life. However, complications can develop, especially if care and monitoring are inconsistent. For example, such mechanical issues as tube blockage, dislodgement, or leakage around the insertion site can occur. Infections may develop at the tube insertion site, especially in long-term placements. Between 4 and 30 percent of patients with PEG experience such infections. Among the most serious risks of tube feeding is aspiration pneumonia, which has mortality rates as high as 62 percent.

Gastrointestinal problems from tube feeding may include nausea, vomiting, bloating, diarrhea, or constipation. Such problems often are due to the formula type or feeding rate. Metabolic complications can include dehydration, electrolyte imbalances, and refeeding syndrome, in which undernourished patients who receive an abrupt intake of large amounts of nutrients experience metabolic shifts with potentially life-threatening complications. In general the risk of many complications associated with tube feeding can be reduced through routine monitoring, proper hygiene, and proper technique.

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Tube removal

Feeding tubes are removed when a patient can safely meet their nutritional needs by mouth or when tube feeding is no longer medically appropriate. This often occurs after improvement in swallowing ability or recovery from an illness or surgery. Removal also becomes necessary if the tube is no longer functioning or if care goals shift, such as in palliative care situations. Whereas nasal feeding tubes can be pulled out, a G-tube or PEG tube requires careful removal, often using local anesthesia, with the insertion site sutured closed or allowed to heal naturally.