Feeding tube
A feeding tube is a medical device used to provide nutrition to people who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. 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 outer diameter of a feeding tube is measured in French units. They are classified by the site of insertion and intended use.
Medical uses
There are more than a dozen of conditions that may require tube feeding to prevent or treat malnutrition. Conditions that necessitate feeding tubes include prematurity, failure to thrive, neurologic and neuromuscular disorders, inability to swallow, anatomical and post-surgical malformations of the mouth and esophagus, cancer, Sanfilippo syndrome, and digestive disorders.Children
Feeding tubes are used widely in children with excellent success for a wide variety of conditions. Some children use them temporarily until they are able to eat on their own, while other children require them for a longer time. Some children only use feeding tubes to supplement their oral diet, while others rely on them exclusively.Dementia
Tube feedings are not recommended for those with advanced dementia. People with advanced dementia who get feeding assistance rather than feeding tubes have better outcomes. Feeding tubes do not increase life expectancy for such people, or protect them from aspiration pneumonia. Feeding tubes can also increase the risk of pressure ulcers, require pharmacological or physical restraints, and lead to distress.Intensive Care Unit
Feeding tubes are often used in the intensive care unit to provide nutrition to people who are critically ill while their medical conditions are addressed. Those who are critically ill have decreased nutrient intake, reduced nutrient utilization and increased inflammation and metabolic needs. Malnutrition in critically ill people is associated with death, prolonged hospitalizations, and hospital readmissions. In critically ill people who have malnutrition or at risk of the disorder, individualized medical nutrition therapy with a dietician is the preferred initial treatment. MNT involves a nutritional assessment, patient counselling to increase nutritional intake, oral nutritional supplements and if required; tube feeds or total parenteral nutrition. In critically ill patients, MNT was associated with a lower risk of death, with a 27% lower risk of death up to 6 months after hospital discharge, lower risk of hospital readmission, increased weight, and increased protein and caloric intake. Tube feeding is preferred over TPN. High protein tube feedings in the ICU have found no benefits as compared to standard feeding, and in some cases was associated with harm. Early tube feeding may also not be beneficial.As of 2016, there was no consensus as to whether nasogastric or gastric tubes led to better outcomes.
Studies assessing tube feedings outside of the critical care setting are lacking.
Mechanical obstruction and dysmotility
There is at least moderate evidence for feeding tubes improving outcomes for chronic malnutrition in people with cancers of the head and neck that obstruct the esophagus and would limit oral intake, people with advanced gastroparesis, and ALS. For long term use, gastric tubes appear to have better outcomes than nasogastric tubes.GI surgery
People who have surgery on their throat or stomach often have a feeding tube while recovering from surgery; a tube leading through the nose and down to the middle part of the small intestine is used, or a tube is directly placed through the abdomen to the small intestine. There is some evidence to suggest that people with a tube through the nose were able to start eating normally sooner and had shorter hospital stays.Product types
Medical nutrition companies make flavored products for drinking and unflavored for tube feeding. In the USA these are regulated as medical foods, which are defined in section 5 of the Orphan Drug Act ) as "a food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation."Types
The most common types of tubes include those placed through the nose, including nasogastric, nasoduodenal, and nasojejunal tubes, and those placed directly into the abdomen, such as a gastrostomy, gastrojejunostomy, or jejunostomy feeding tube.Nasogastric feeding tube
A nasogastric feeding tube or NG-tube is passed through the nares, down the esophagus and into the stomach. This type of feeding tube is generally used for short term feeding, usually less than a month, though some infants and children may use an NG-tube longterm. Individuals who need tube feeding for a longer period of time are typically transitioned to a more permanent gastric feeding tube. The primary advantage of the NG-tube is that it is temporary and relatively non-invasive to place, meaning it can be removed or replaced at any time without surgery. NG-tubes can have complications, particularly related to accidental removal of the tube and nasal irritation. More specifically, when nasogastric or nasoenteric tubes are placed incorrectly, they can damage patients' vocal cords, lungs, or trachea, resulting in serious injuries or even death.In March 2022, Avanos Medical's Cortrak2 EAS recall, for instance, has been classified as a Class I recall by the FDA, following reports of injuries and patient deaths caused by misplaced nasoenteric or nasogastric tubes.
Nasojejunal feeding tube
A nasojejunal or NJ-tube is similar to an NG-tube except that it is threaded through the stomach and into the jejunum, the middle section of the small intestine. In some cases, a nasoduodenal or ND-tube may be placed into the duodenum, the first part of the small intestine. These types of tube are used for individuals who are unable to tolerate feeding into the stomach, due to dysfunction of the stomach, impaired gastric motility, severe reflux or vomiting. These types of tubes must be placed in a hospital setting.Gastrostomy or gastric feeding tube
A gastric feeding tube is a tube inserted through a small incision in the abdomen into the stomach and is used for long-term enteral nutrition. One type is the percutaneous endoscopic gastrostomy tube which is placed endoscopically. The position of the endoscope can be visualized on the outside of the person'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 or by a retention dome which is wider than the tract of the tube. G-tubes may also be placed surgically, using either an open or laparoscopic technique.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, and to decrease the risk of aspiration pneumonia. However, in people with advanced dementia or adult failure to thrive, it does not decrease the risk of pneumonia. There is moderate quality evidence suggesting that the risk of aspiration pneumonia may be reduced by inserting the feeding tube into the duodenum or the jejunum, when compared to inserting the feeding tube into the stomach. People with dementia may attempt to remove the PEG, which causes complications.