Tube feedings are given when a person is unable to eat or tolerate enough food and/or oral supplements to meet his/her
nutritional needs. Specific feeding instructions depend on the amount and type of tube being used. If you are taking care
of someone who is on tube feeding, you will need specific directions from your healthcare providers (dietitian, doctor, and/or
nurse).
There are three basic kinds of feeding tubes:
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A naso-gastric
tube (NGT) is threaded through a nostril, down the throat and into the stomach. This type of feeding is usually temporary
and does not require surgery to be put in. One disadvantage is that it can be pulled out accidentally. A naso-gastric tube also interferes with swallowing, which is a disadvantage is the person is able to eat.
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A peri-epigastric
tube (PEG), or gastrostomy tube (G-tube), is a tube that is implanted through the abdomen into the stomach. It functions in
essentially the same way as an NGT. Formula flows through the tube into the stomach. It is usually for long-term use. As it
does not pass down the throat, the patient can receive both tube feedings and an oral diet. It is a good idea to continue
oral feeding as long as possible, even if the quantities given are not nutritionally significant, as this can provide significant
psychological benefits.
A new type of tube in this category is called a "button" tube.
It is a very short tube attached to the stomach with a longer "snap on" tube for use during feedings. When the tube is not
in use, a plastic cap covers the opening. This can be useful for people who do not receive a feeding constantly over 24 hours
(e.g., bolus feeding, feedings run only at night, etc.).
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A jejunostomy
tube (J-tube) is implanted below the stomach, directly into the small intestine. It functions similarly to tubes leading into
the stomach, but with several differences. The advantage of a J-tube is that it reduces the risk that formula will back up
into the esophagus into the trachea and lungs. This is called "aspiration," and for someone at high risk of aspiration, the
J-tube might be the preferred option. Increased probability of diarrhea, and increased probability of the (very narrow) tube
getting clogged, are some disadvantages.
Feedings
are either "continuous" or "bolus" servings. As the name implies, continuous feedings run down the feeding tube at a fixed
rate throughout the day and/or night. Tolerance problems are usually minimized when feedings are given in this way. A very
weak or debilitated patient may need to be fed continuously in order to tolerate enough intake to meet his or her needs. Patients
at risk for regurgitation because of limited stomach capacity need continuous feeding. |
Most
patients who are just starting out on tube feedings are given continuous feedings and then gradually changed over to bolus
feedings.
Bolus
feedings are essentially the equivalent of a meal, consisting entirely of formula. A "bolus" is a set amount of formula run
down the feeding tube at specific times during the day. These usually, but not always, correspond to breakfast, lunch and
dinner times. Some regimens include one or more bolus "snacks" as well, for a total of four to six feedings per day. Bolus feedings are usually more convenient for caregivers, since feedings are administered
only at specific times, and larger amounts are given at each sitting.
It should be noted that for some people, the weight gain achieved after the gastric tube insertion leads to
an improvement in swallowing ability. This improvement may allow a person to resume eating.
Some Additional Tips
About
Tube Feedings:
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Position
the person so that he or she is sitting up, or at least so the upper-body is above the level of the stomach.
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Practice
good sanitation. Wash your hands before handling the feeding equipment. Wash feeding bags with water. Do not use soap, as
it will stick to the inside of the bag and get into the formula. This can cause diarrhea and other unpleasant consequences.
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Feedings
should be given at room temperature to minimize risk of cramping and/or diarrhea. Open cans of formula could be kept in the
refrigerator, and discarded if not used within 24 hours. They should be taken out 15-20 minutes before a feeding and allowed
to warm up to room temperature.
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Always
flush the feeding tube with water after a feeding. This will help to prevent the patient from getting dehydrated. It will
also prevent the food from getting clogged.
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If medications
are to be run down the feeding tube, always be sure they are finely crushed. Flush the tube with water to wash them down.
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If the
tube seems to be clogged and a small flush of water isn't effective, a flush of about 100cc of cola may do the trick. You
can also try dissolving a quarter teaspoon of meat tenderizer in a teaspoon of water and placing it into the tube. Wait five
minutes before flushing again. If none of these strategies work, contact your health care provider(s) for advice. |
