Definition of Tube Feeding

Tube feeding is a means of providing nourishment to those who are unable or unwilling to eat normally. Tube feeding would seem to be a relatively simple procedure of no extraordinary significance. However, the courts and medical practitioners view it as an artificial means of sustaining life and, as such, is an issue fraught with ethical, legal and medical implications.

Types

• There are two main types of tube feeding: percutaneous endoscopic gastrostomy (PEG) and nasogastric (NG) intubation. PEG is the treatment of choice for patients who must be supplied with nourishment over an extended period of time, usually defined as 30 days or more. NG is most often used for short-term applications, when the patient is unable to eat on his own for a brief period.

Methods

• An NG tube is threaded through one of the patient's nostrils and passed through the esophagus to the stomach or the upper reaches of the small intestine. The patient is likely to receive some sort of local anesthetic to counter the discomfort involved in placement of the tube, and he also might be lightly sedated to make the process more tolerable.

  The PEG tube is inserted into the stomach through an incision in the abdominal wall. To ensure that the tube is properly placed, the doctor first threads an endoscope with a camera on its forward tip through the mouth, down the esophagus and into the stomach. Once the scope is in place, the doctor can monitor the positioning of the feeding tube as it is inserted into the stomach.

Candidates

• Candidates for tube feeding include infants who are unable to suck or swallow enough for sound nutrition, as well as people who are being treated for a stroke, neurological disease, head injuries and collagen vascular disorders. This method of feeding is also used in patients with depression; dementia; cancerous obstructions of the mouth, throat or esophagus; anorexia nervosa; and other disorders in which the patient refuses to eat on his own.

Considerations

• Tube feeding raises some complex medical, legal and ethical issues, according to Dr. David Milkes, a New York-based gastroenterologist. In an article written for TheDoctorWillSeeYouNow.com, Milkes states that the courts have upheld the legal right of competent patients to refuse tube feeding. However, that leaves open the legal and ethical questions of how to deal with patients who are either mentally incompetent or physically unable to make their preferences known. The logic and ethics of tube feeding in terminal patients are also widely debated.

Complications

• Both types of tube feeding can cause complications, some of them very serious. NG intubation carries the risk of irritating or even perforating the mucosal lining of the throat, esophagus and stomach; sinusitis; a pneumothorax (collapsed lung); and nosebleed. Minor PEG complications, according to Milkes, include an obstruction in the tube, local skin infection, self-limited abdominal pain and/or bleeding, and inadvertent removal of the tube. Possible major complications are aspiration pneumonia, necrotizing fasciitis, severe bleeding, perforation, peritonitis and death.