Tube Feeding

What is tube feeding?

Tube feeding is a special liquid food mixture given through a tube in the stomach or small intestine. It provides nutrition when you are not able to swallow or digest regular food. It is also called enteral nutrition. Tube feeding is an alternative to getting nutrition through your veins (IV).

When are tube feedings used?

If you cannot eat in the usual way, you may not be getting enough nutrition for good health. You may need tube feeding to get good nutrition.

There are many reasons why you may not be able to eat normally.

• You may be so ill that you are too sick to eat. For example, this may happen if you have:
  • AIDS
  • burns
  • cancer
  • kidney problems
  • liver problems
  • lung problems
  • pancreas problems
  • stomach problems
  • surgery.
• You may have trouble swallowing—for example, because of a stroke. If swallowing is hard for you, you may breathe food into the lungs, and food in the lungs can cause pneumonia. People in a coma need to be fed by tube if they are to remain alive.
• You may not be eating enough food because of a problem like dementia or depression.

Parenteral nutrition is another way you can get nutrition when you cannot eat. It is a special liquid food mixture given into the blood with a needle through a vein. In this case the food does not go through your digestive system. It is sometimes called total parenteral nutrition, TPN, or hyperalimentation. TPN is usually used for a shorter time than tube feeding. Tube feeding is less costly, has less risk of infection, and keeps the digestive system working better than TPN.

Tube feeding may be temporary or permanent. Some people need tube feeding while they are getting better during an illness. Other people may need to have tube feedings for the rest of their lives.

If you do not want to have tube feeding, or if you have a fatal illness, it may not be the best choice for you. You and your family must decide whether or not tube feeding is right for you.

How does tube feeding work?

A dietitian figures out which nutrients (vitamins, minerals, fluids) and how many calories you need each day. Then the dietitian chooses the right formula to meet those needs. The formula may be a ready-made formula you can buy at the store, or it may be possible to make the formula more cheaply at home.

Formulas may be given in 3 ways:

• Enteral feeding pump: The formula is given over an extended period of time at a slow, set rate. The feeding can be interrupted for periods of time to allow activity.
• Gravity drip: Formula is allowed to drip slowly through the tube over a period of time and is divided into 3 to 6 separate feedings.
• Bolus feeding. A larger amount of formula is given by syringe over 30 to 45 minutes 3 to 6 times a day. This method is faster and uses less equipment. Taking the feedings too but can cause problems such as nausea and diarrhea if the feeding is given too rapidly

You may be able to keep eating by mouth while you are having tube feedings to ensure that you get all of the nutrients you need.

How are the tubes placed?

The tubes are made of plastic or silicon. They may be placed in different ways:

• Nasogastric placement: The tube is put through the nose and down into the stomach or small intestine. This does not require surgery.

  Many people find this kind of tube feeding uncomfortable. Also, it is easy for the tube to move out of place. Nasogastric tubes may be used when tube feeding is needed for only a short time (days or weeks).

• Gastrostomy placement: For this type of tube feeding, you are given an anesthetic so that you will not feel any pain and then one or more cuts are made in the skin of your abdomen. Your healthcare provider will place a feeding tube into the stomach through a cut in your belly. Your provider may use a scope passed through the mouth into the esophagus or X-rays to guide placement of the tube. A balloon or rubber cap keeps the tube in place in the stomach.

  Gastrostomy tubes are used when tube feeding is needed for months or more. They are more comfortable than nasogastric tubes.

The tube can usually be used for feeding within 12 to 24 hours after if has been placed. You or your caregiver may be taught how to use and care for the feeding tube at home.

The tube will be changed for a new one if it becomes plugged or at regular scheduled intervals. Replacing a tube is a fairly simple outpatient procedure that can be done in your healthcare provider's office.

Are there any problems with tube feeding?

Some of the problems that might happen with tube feeding are:

• The digestive system may not work properly. Your bowel movements may be looser, or you may have constipation. Changing formulas or giving less food at one time can usually help this problem.
• The tube may get clogged or shift into the wrong place. If a nasogastric tube is pulled out too far, liquid feedings can get into the lungs and cause pneumonia.
• The body's chemistry can be affected by the formula. This may mean that your body is absorbing too much or too little of various nutrients. The doctor or dietitian can help with this.
• Eating is a very important social activity. You may feel self-conscious about eating differently from others around you. There may have to be extra equipment in your home for the feedings. You may need help in preparing or getting the feedings and may not like feeling dependent on someone else.
• If you can no longer enjoy tasting, chewing, and swallowing a variety of foods, you may feel angry, sad, or depressed. You may have mixed feelings about relying on tube feedings.

Can a person refuse to be fed with a tube?

Any competent adult--that is, someone who is capable of making decisions for himself or herself--can accept or refuse tube feeding. Once the treatment is started, a competent adult can decide to stop the treatment at any time. If you are not able to make your own decisions, your healthcare provider will ask your family, legal guardian, or person appointed in a healthcare power of attorney to make the decision about tube feeding.

Since not getting food and fluids over time will cause death, refusing tube feedings is often a hard decision for you and your family. Consider signing an advance directive that addresses the use of tube feeding. You might also want to talk with the ethics committee of your local hospital or nursing facility. Their job is to help you look at all the options.