Peg Tube Feeding Nutrition

In a world where obesity is a weekly headline, we don't often hear about those on the other end of the scale. People who cannot maintain a minimum healthy weight must seek other ways of ingesting nutrients.

What is a peg tube?

• A peg tube---also called a gastronomy tube (g-tube) or feeding tube---is a device that allows people with poor nutrition to supplement or replace eating. The tube extends from the inside of the stomach through the abdominal wall to the outside of the body. It is held in place on the inside of the stomach by an inflatable balloon or plastic dome. The tube must be inserted surgically, but it may be replaced periodically without surgery. Formula is pushed through the tube and into the stomach.

Reason for having a peg tube

• People who cannot consume adequate calories and nutrients orally must resort to feeding through a peg tube (enteral feeding). According to Merck Manuals, common reasons include inability to eat due to injury; prolonged anorexia, chronic malnutrition, liver failure or iIllness or injury, such as burns, that causes metabolic stress.

Modes of enteral feeding

• There are several modes of feeding, and finding which is best for you can involve some trial and error.

  Continuous feeding involves being constantly connected to a pump that pushes the formula through the tube. The patient will receive a slow and continuous amount of formula, which keeps a steady level of nutrients in the system and reduces the risk of intolerance. Its disadvantages include being connected to a pump constantly, which mobile patients will find cumbersome.

  Intermittent feeding still requires a pump, but the formula is administered at a faster rate over a shorter amount of time. Feeds are most commonly done overnight so that a patient can sleep through the time he must be connected. This is ideal for people who are merely supplementing a regular diet and who may not need to use the peg tube every day. Intermittent feeds last about eight hours.

  Bolus feeding is the least intrusive method, but it also has the most potential for making a patient feel ill. To administer bolus feeding, fill a large syringe with the formula and push it through the tube manually over a period of about 15 minutes. This has many of the same advantages as intermittent feeding and takes a significantly shorter amount of time. The biggest disadvantage is intolerance to the rate at which formula enters the stomach. The patient may become nauseous, experience abdominal pain, and vomit. Vomiting will require repeating the feed because no formula will be left in the stomach.

Choosing a formula

• There is a large variety of formulas meant to address different needs. Some formulas can be purchased over the counter. Brands like Boost and Ensure are common. Formula for people with enzyme deficiencies has a very low fat content so it is easier to digest, but it still has a great number of calories. Some have no lactose, and some have very specialized ingredients to treat specific ailments. All have a large vitamin content to encourage proper nutrition. Only a doctor can determine which formula is best for each patient.

  Insurance will often cover the placement of the tube, but not the formula. If you must pay out of pocket for formula, wholesale warehouses and medical supply stores often charge less than drug companies. Talk to your dietitian about possible financial aid programs.

Possible complications

• Complications can include infection of tube site, especially when the tube is first placed. Watch for infection and granulation tissue. Both can be treated with creams. Blockage of the tube, usually due to thick formula or pushing medications through the tube can also occur. Sometimes an intolerance to the formula will develop, resulting in diarrhea, nausea, vomiting, and abdominal discomfort. If this is the case, your doctor will recommend a change of formula or feeding method. Increased acid reflux (aspiration) is another possible complication.

Peg tube maintenance

• Keep the site clean by washing with soap and water in the shower. Flush the tube with water before and after each feed to avoid blockages. Change the tube every six months or as directed by a doctor.