Feeding tube
Encyclopedia
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 gavage, 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 unit
s (each French unit equals 0.33 millimeters). They are classified by site of insertion and intended use.
or NG-tube is passed through the nares (nostril), down the esophagus and into the stomach. This type of feeding tube is generally used for short term feeding, usually only 2 weeks maximum.
and is used for long-term enteral nutrition. One 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 feeding tubes are suitable for long-term use, though they sometimes need to be replaced if used long term. The G-tube can be 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
. However, in patients with advanced dementia
or adult failure to thrive
it does not decrease the risk of pneumonia.
(the second part of the small intestine
). The procedure is called a jejunostomy
.
or adult failure to thrive
and expert opinion recommends they not be offered to these patients. Studies have definitively proven to they do not prolong life, they do not decrease the risk of pneumonia, they do not improve wound healing, they do not help weight gain, and they do not help the patient regain any strength or functional ability such as walking or self-care. Patients with advanced dementia also often pull at their G tubes causing them to be dislodged, and frequently require physical restraints, such as tying their wrists to the bed, to keep this from happening.
for more than three days.
As feeding tubes are placed as a procedure that punches a hole in the stomach and skin, this can lead to leaking of contents into the abdomen causing severe infection and death. This is a rare, but serious complication.
The most frequent complication is irritation around the site of the insertion, generally caused by stomach acid and feedings leaking around the site. Barrier creams, dressings, and frequent cleaning is generally recommended.
Especially in advanced dementia, patients can pull at the feeding tubes causing them to be dislodged and requiring a hospitalization to replace them.
Feeding tubes may become clogged or occluded if not flushed with water after each feeding. A clogged tube may need to be replaced.
Some patients or families will opt for a "time limited trial" of feeding through a tube, but after a set time period if the individial is not improving feedings are stopped and the goals of care are refocused to comfort measures.
A variety of feeding tubes are used in medical practice. They are usually made of polyurethane
Polyurethane
A polyurethane is any polymer composed of a chain of organic units joined by carbamate links. Polyurethane polymers are formed through step-growth polymerization, by reacting a monomer with another monomer in the presence of a catalyst.Polyurethanes are...
or silicone. The diameter of a feeding tube is measured in French unit
French catheter scale
The French scale or French gauge system is commonly used to measure the size of a catheter. It is most often abbreviated as Fr, but can often abbreviated as FR or F. It may also be abbreviated as CH or Ch in French speaking countries...
s (each French unit equals 0.33 millimeters). They are classified by site of insertion and intended use.
Nasogastric
A nasogastric feeding tubeNasogastric intubation
Nasogastric intubation is a medical process involving the insertion of a plastic tube through the nose, past the throat, and down into the stomach.-Uses:...
or NG-tube is passed through the nares (nostril), down the esophagus and into the stomach. This type of feeding tube is generally used for short term feeding, usually only 2 weeks maximum.
Gastric feeding tube
A gastric feeding tube (G-tube or "button") is a tube inserted through a small incision in the abdomen into the stomachStomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
and is used for long-term enteral nutrition. One type is the percutaneous endoscopic gastrostomy
Percutaneous endoscopic gastrostomy
Percutaneous endoscopic gastrostomy is an endoscopic medical procedure in which a tube is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate. The procedure is an alternative to surgical gastrostomy insertion, and...
(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 feeding tubes are suitable for long-term use, though they sometimes need to be replaced if used long term. The G-tube can be useful where there is difficulty with swallowing because of neurologic or anatomic disorders (stroke, esophageal atresia
Esophageal atresia
Esophageal atresia is a congenital medical condition which affects the alimentary tract. It causes the esophagus to end in a blind-ended pouch rather than connecting normally to the stomach. It comprises a variety of congenital anatomic defects that are caused by an abnormal embryological...
, tracheoesophageal fistula), and to avoid the risk of aspiration pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
. However, in patients with advanced dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
or adult failure to thrive
Failure to thrive
Failure to thrive is a medical term which is used in both pediatric and adult human medicine, as well as veterinary medicine ....
it does not decrease the risk of pneumonia.
Jejunostomy feeding tube
A jejunostomy feeding tube (J-tube) is a tube surgically inserted through the abdomen and into the jejunumJejunum
The jejunum is the middle section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms middle intestine or mid-gut may be used instead of jejunum.The jejunum lies between the duodenum...
(the second part of the small intestine
Small intestine
The small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to...
). The procedure is called a jejunostomy
Jejunostomy
Jejunostomy refers to an artificial opening into the jejunum. It is performed to allow feeding tube placement. Jejunostomy is an alternative to gastrostomy when the stomach is unsuitable for a feeding tube....
.
Effectiveness
The effectiveness of feeding tubes varies greatly depending on what condition they are used to treat.Advanced Dementia and Adult Failure to Thrive
There is strong evidence that feedings tubes do not help patients with advanced dementiaDementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
or adult failure to thrive
Failure to thrive
Failure to thrive is a medical term which is used in both pediatric and adult human medicine, as well as veterinary medicine ....
and expert opinion recommends they not be offered to these patients. Studies have definitively proven to they do not prolong life, they do not decrease the risk of pneumonia, they do not improve wound healing, they do not help weight gain, and they do not help the patient regain any strength or functional ability such as walking or self-care. Patients with advanced dementia also often pull at their G tubes causing them to be dislodged, and frequently require physical restraints, such as tying their wrists to the bed, to keep this from happening.
ICU
Nasogastric tubes are often used in the intensive care unit to provide nutrition to critically ill patients while their medical conditions are addressed. There is moderate evidence for use of feeding tubes in the ICU, especially if requiring mechanical ventilationMechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
for more than three days.
Neurologic Disease and Mechanical Obstruction
There is at least moderate evidence for feeding tubes improving outcomes for chronic nutrition in patients with cancers of the head and neck, acute stroke while the patient undergoes rehab, and ALSALS
ALS refers to amyotrophic lateral sclerosis, also known as Lou Gehrig's diseaseIt may also refer to:-Medicine:* Advanced life support, a level of medical training* Anterolateral system, part of the nervous system...
Advanced Cancer
There is no evidence that feeding tubes are beneficial in any way for patients who are losing weight with advanced cancer that is not directly related to problems swallowing due to the cancer, such as cancers of the throat or esophagus. Feeding tubes are frequently used in these populations, but studies to date have yet to prove that they are helpful.Complications of Feeding Tubes
Gastric feeding tubes have a variety of complications that can occur, though the overall rate of complication is about 1%.As feeding tubes are placed as a procedure that punches a hole in the stomach and skin, this can lead to leaking of contents into the abdomen causing severe infection and death. This is a rare, but serious complication.
The most frequent complication is irritation around the site of the insertion, generally caused by stomach acid and feedings leaking around the site. Barrier creams, dressings, and frequent cleaning is generally recommended.
Especially in advanced dementia, patients can pull at the feeding tubes causing them to be dislodged and requiring a hospitalization to replace them.
Feeding tubes may become clogged or occluded if not flushed with water after each feeding. A clogged tube may need to be replaced.
Withdrawal
Tube feeding, like all medical treatments, can be declined or stopped, 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 if desired.Some patients or families will opt for a "time limited trial" of feeding through a tube, but after a set time period if the individial is not improving feedings are stopped and the goals of care are refocused to comfort measures.
See also
- BioethicsBioethicsBioethics is the study of controversial ethics brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy....
- Force-feedingForce-feedingForce-feeding is the practice of feeding a person or an animal against their will. "Gavage" is supplying a nutritional substance by means of a small plastic tube passed through the nose or mouth into the stomach, not explicitly 'forcibly'....
for tube feeding against an individual's will or as torture - Nutrient enemaNutrient enemaA nutrient enema, also known as feeding per rectum, rectal alimentation, or rectal feeding, is an enema administered with the intent of providing nutrition when normal eating is not possible...
- Saline flushSaline FlushA saline flush is the method of clearing out feeding tubes and intravenous lines of any food, medicine, or other perishable liquids so that they can keep the area of entering clean and sterile. Typically in flushing a intravenous cannula, a 5ml syringe of saline is emptied into the medication port...
- Nasogastric tube