Enteral Feeding Tubes

Enteral Feeding: The What, When, and How

Enteral feeding is often a short-term solution used to feed patients who are recovering from an injury, illness, or surgery. Upon recovery, patients can resume eating normally.

What is Enteral Feeding?

Enteral feeding is a process of food intake via the gastrointestinal (GI) tract, comprising of mouth, esophagus, stomach, and intestines. Tube feeding helps take nutrition via the mouth or a tube directly to the stomach or small intestine.

A person with a condition or injury that makes eating normally, i.e., via mouth difficult, but has a properly functioning GI tract, may be fed via a tube. Tube feeding allows them to receive nutrition and keep their GI tract healthy.

Enteral feeding is used as a supplement. However, often it makes up their total caloric intake.

When is Enteral Feeding used?

Tube feeding becomes necessary if one can't eat enough calories to meet their nutritional needs. Deficiency in calories may be caused due to the lack of physical intake of food or increased caloric requirement, which is not met by eating alone.

An anorexic person is at high risk for malnourishment, weight loss, and other serious health concerns. Similarly, a person who cannot eat adequately may suffer severe health issues.

Why use Tube Feeding?

Some of the most common reasons for enteral tube feeding are

• A stroke that may trigger dysphagia
• Cancer that causes vomiting, nausea, and fatigue while taking a meal
• Severe injury or illness that leads to reduced energy or strength to consume food
• Incapability in young children or infants to eat
• Serious illness or injury puts the body under duress and makes consuming adequate nutrients troublesome
• Neurological disorders increase caloric requirements, but make it hard to swallow food manually
• Gastrointestinal dysfunction or disease that calls for intravenous (IV) nutrition

Types of Enteral Feeding Tubes

The American College of Gastroenterology propounds six main types of feeding tubes, classified further into subtypes based on their placement in the stomach or intestines. The tube placement is decided by a doctor and largely depends on the size of the tube required, duration of enteral feeding, and the digestive abilities of the patient.

Subsequently, the right enteral formula is also chosen for the patient, considering their digestive abilities, tube placement, and nutritional necessities. Enteral feeding tubes include:

• NGT: The nasogastric tube starts in the nose and ends in the stomach
• OGT: The orogastric tube (OGT) begins in the mouth and ends in the stomach
• Nasoenteric tube: Initiates in the nose and ends in the intestines
• Oroenteric tube: Begins in the mouth and ends in the intestines
• Gastrostomy tube: Placed through the abdomen skin straight to the stomach
• Jejunostomy tube: Placed through the abdomen skin straight into the intestines

Feeding Tube Insertion - How to place an NGT or OGT?

An NG or OG tube placement is fairly straightforward and painless hence anesthesia is not necessary. Normally, a nurse measures the tube length, lubricates the tip, places the tube in the patient's nose or mouth, and advances till the tube is in the stomach. Then the tube is secured to the skin using soft tape.

Once the tube is secured, the nurse uses a syringe and pulls some gastric juice out of the tube. This is to check the pH (acidity) of the liquid and confirm if the tube is in the stomach. Sometimes a chest X-ray might be done to confirm the placement. The tube is used immediately after the proper establishment.

How to place a Nasoenteric or Oroenteric tube?

Often, tubes ending in the intestines call for endoscopic placement. The placement is done using a thin tube called an endoscope with a tiny camera at the end to place the feeding tube. The camera is to assist the person in placing the tube. Later the endoscope is removed, and placement of the feed tube is confirmed with gastric contents or X-ray.

Normally, a patient is advised to wait for 4-12 hours before using the new feeding tube. Some people are awake throughout the procedure, while others require conscious sedation. Although no recovery from the tube placement itself is needed, the sedatives take an hour or so to wear off.

How to insert a Gastrostomy or Jejunostomy tube?

Gastrostomy or jejunostomy tube placement may require conscious sedation or occasionally general anesthesia. The nurse or doctor visualizes where the tube needs to go with an endoscope. A tiny cut in the abdomen is made to feed the tube into the stomach or intestines. Soft medical tape is then used to secure it to the skin. Some endoscopists choose to wait 12 hours before a new feeding tube is used.

It may take a person five to seven days to recover. Some people may experience discomfort at the incision site, but the incision is so small that it normally heals well. Patients are also provided antibiotics to prevent infection.

Complications of Enteral Feeding

Enteral Feeding may cause some complications, including -

• Aspiration, i.e., accidental breathing in food or fluid into the lungs
• Refeeding syndrome, i.e., potentially fatal shifts in fluids and electrolytes occurring in malnourished patients receiving enteral feeding
• Tubal infection or bacterial infection on the tube insertion site
• Nausea and vomiting due to the large tube or the speed of emptying the stomach
• Possible skin irritation at the insertion site
• Diarrhea is a probable side effect of medicines or a liquid diet
• Tube blockage if not flushed properly
• Tube dislodgement

There are no long-term complications of artificial feeding. It is noteworthy that a person may experience digestive discomfort initially after resuming normal eating since the body starts to adapt to solid foods again.

What are the contraindications for Enteral Feeding?

 Enteral nutrition should not be given to a person if they already have some stomach or intestines issues or their stomach or intestines are not functioning properly.

Additionally, someone with a bowel obstruction, ischemic bowel, i.e., decreased blood flow to their intestines, or severe intestinal disease like Crohn's disease should not be given enteral nutrition.

Enteral nutrition may be used for someone critically ill or an older person to meet their nutritional needs. Some medical conditions render a person incapable of eating normally, such as a movement disorder or a congenital disorder in children.

In such situations, enteral feeding may be a long-term resort. The reason for using enteral feeding may vary from person to person, but the end goal remains the same – to preserve and prolong life.

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