Tube Feeding Information

A feeding tube is a medical device used to deliver nutrients that are mostly in liquefied or pureed form. In general, there are two feeding tube routes that differ on the intended duration of use; for instance, the nasal route is intended for short-term use. Furthermore, feeding tubes may be classified into three nutrient-delivery methods: syringe or bolus method, pump method and gravity method.

Facts

• The feeding tubes are utilized to help deliver nutrients when a patient is unable to eat, for example, after a surgical procedure in the face, whereby the area around the cheeks and mouth must be covered. Nutrients, either a pureed food or a liquefied food formulation that may include medicine, vitamins and minerals, are delivered through the tubes into the gastrointestinal tract.

Delivery Methods

• The bolus or syringe method uses a syringe needle to deliver the nutrient formula into the feeding tube and, via gravity, allows nutrient delivery on a scheduled basis. In the gravity drip method, a formula bag is connected to the feeding tube and hung on an intravenous (IV) rack beside the patient. The pump feeding method delivers the nutrients via an electronic device. This method is used for jejunum feeding tubes to ensure that the formula makes it into the GI tract.

Feeding Tube Routes

• There are two main routes of feeding tube insertion: via the nasopharyx (for example, nasogastric tube feeding) and via the skin (for example, jejunostomy tube feeding). Feeding tubes are placed surgically, radiologically or endoscopically. Radiological operations utilize radioactive substances, such as X-ray dyes, to monitor the feeding tubes. On the other hand, endoscopic methods monitor the feeding tubes via an instrument called an endoscope, which enables photography of the environment surrounding the tubes to visualize the actual operation.

Nasoenteric Feeding Tubes

• There are three categories of feeding tube insertion via the nasal route, namely, nasogastric (NG), nasoduodenal (ND) and nasojejunal (NJ). In nasogastric, the tube is inserted in the nostril, passed down the pharynx down to the esophagus and then into the stomach. In nasoduodenal, also referred as "postpyloric," the tube is inserted in the same manner as in the NG route, but it passes the duodenum, which is the first part of small intestine. ND is used to overcome the problems associated with gastric stasis (gastric disturbance). In nasojejunal, the tube is inserted in the same manner as in ND route, but it passes the jejunum, which is the middle part of the small intestine. The tubes are secured at the nose with a surgical tape after the proper placement is checked.

Enterostomy Feeding Tubes

• There are two categories of feeding tube insertion via enterostomy or through the skin, namely, percutaneous gastrostomy and percutaneous jejunostomy. All enterostomy feeding tubes are directly inserted into the gastrointestinal tract, and differ only on the entry point.

  In percutaneous gastrostomy, also known as percutaneous endoscopic gastrostomy (PEG), the tubes enter the GI tract via the abdominal lining of the stomach. The PEG tube is held in place with an internal "balloon" and an external fixator. While in percutaneous jejunostomy, or percutaneous endoscopic jejunostomy (PEJ), the tube is implanted in the jejunum. The PEJ tube is held in place either externally with stitches or internally with a surgical device called a Dacron cuff.