A Parenteral Feeding Tube May Be Attached to the Patient

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Tube feeding may be used to feed people whose digestive tract is functioning normally but who cannot eat enough to meet their nutritional needs. Such people include those with the following:

• A poor appetite for a long time

• Coma or greatly reduced alertness

• Liver failure

• A head or neck injury or another disorder that makes them unable to eat by mouth

• A serious illness (such as burns) that increases nutritional requirements

• It better preserves the structure and function of the digestive tract.

• Cost is lower.

• It probably causes fewer complications, particularly infections.

Where a feeding tube is inserted usually depends on how long tube feeding is needed:

• For less than 4 to 6 weeks: A thin plastic tube is passed through the nose and down the throat until it reaches the stomach (called a nasogastric tube) or the small intestine (called a nasoduodenal tube). If the nose is damaged, the tube may be inserted through the mouth.

• For longer than 4 to 6 weeks: The tube is inserted directly into the stomach or small intestine through a small incision in the abdomen.

Nasogastric and nasoduodenal tubes can usually be inserted while the person is awake. The tube is lubricated and inserted into the nose and down the throat. A tube can cause gagging when it enters the throat, so the person is asked to swallow or is given water through a straw to help with swallowing. Swallowing can decrease or prevent gagging and help the tube pass down the throat. Once the tube is down the throat and enters the esophagus, it can be easily slid into the stomach or small intestine. Doctors sometimes do tests, such as an x-ray of the abdomen, to make sure the tube is correctly placed.

When a feeding tube must be inserted directly into the stomach or small intestine, a percutaneous endoscopic gastrostomy (PEG) tube is often used.

Before a PEG tube is inserted, people are given a sedative and sometimes a painkiller, usually intravenously. Also, a numbing spray may be sprayed on the back of their throat to suppress the urge to cough or gag. Then doctors insert an endoscope through the mouth and into the stomach or small intestine. The endoscope has a camera on its tip, enabling doctors to view the interior of the stomach and determine where to place the PEG tube. Doctors then make a small incision in the abdomen and insert the PEG tube. People must fast before the procedure, and eating and drinking are limited after the test is completed until the gag reflex returns.

If a PEG tube cannot be placed, a surgical procedure may be used to help doctors place the feeding tube directly into the stomach or small intestine. This procedure may be done in one of the following ways:

• Using a viewing tube (laparoscope), which requires only a tiny incision just below the navel

• Making a relatively large incision in the abdomen because doctors need to view the area through the incision so that they can place the tube in the correct place

People with feeding tubes should be sitting upright or with the head of the bed elevated during feeding and for 1 to 2 hours afterward. This position reduces the risk that they will inhale the food, and it allows gravity to help move the food through the digestive tract.

Typically, a relatively large amount of food (called a bolus) is given several times a day. However, if these feedings cause nausea, small amounts of food are given continuously.

Several different formulas are available for tube feeding. Typically, a formula that provides a complete balanced diet is used. Some formulas are designed to treat a specific deficiency and may contain a single nutrient, such as proteins Proteins Carbohydrates, proteins, and fats are the main types of macronutrients in food (nutrients that are required daily in large quantities). They supply 90% of the dry weight of the diet and 100%... read more , fats Fats Carbohydrates, proteins, and fats are the main types of macronutrients in food (nutrients that are required daily in large quantities). They supply 90% of the dry weight of the diet and 100%... read more , or carbohydrates Carbohydrates, Proteins, and Fats Carbohydrates, proteins, and fats are the main types of macronutrients in food (nutrients that are required daily in large quantities). They supply 90% of the dry weight of the diet and 100%... read more .

Also, specialized formulas are available for people with specific needs. They include the following:

• Concentrated formulas with less fluid for people whose fluid intake is limited

• Fiber-enriched formulas for people who are constipated

• Lactose-free formulas for people who are lactose-intolerant

Complications of tube feeding are common and can be serious.

Possible Problems With Tube Feeding

Problem	Possible Effects	Comments
Tube-related
Presence of the tube in the nose or mouth	Discomfort Damage to the nose, throat, or esophagus Sinusitis Sinusitis Sinusitis is inflammation of the sinuses, most commonly caused by a viral or bacterial infection or by an allergy. Some of the most common symptoms of sinusitis are pain, tenderness, nasal congestion... read more	A tube in the nose or mouth, particularly if large, can irritate tissues, causing pain and sometimes bleeding. In such cases, the tube is usually removed, and feedings are continued with a different kind of feeding tube. Sinuses can become blocked, making infections (sinusitis) more likely.
Incorrect placement of the tube inserted through the nose or mouth	Damage to the affected area Coughing and gagging Pneumonia Overview of Pneumonia Pneumonia is an infection of the small air sacs of the lungs (alveoli) and the tissues around them. Pneumonia is one of the most common causes of death worldwide. Often, pneumonia is the final... read more	Rarely, a tube in the nose or mouth goes down the airways rather than the esophagus. As a result, food can enter the lungs. When the tube is placed in the airways, people who are conscious and alert cough and gag.
Incorrect replacement of a tube previously placed directly into the stomach or intestine	Peritonitis Peritonitis Abdominal pain is common and often minor. Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem. The pain may be the only sign of the need for surgery... read more	When a tube shifts out of place, it must be removed and placed again. If the tube was originally inserted directly into the stomach or intestine, reinserting the tube is more difficult, and the tube may be placed outside the digestive tract. Then food can enter the space around the abdominal organs (abdominal cavity). As a result, the membrane that lines that space may become infected—a serious infection called peritonitis.
Blockage of a tube	Inadequate nutrition	Thick formulas or pills can block a tube. Sometimes doctors can dissolve the blockage by adding certain enzymes or substances formulated to break foods down.
Accidental expulsion of a tube	Inadequate nutrition	Tubes often come out accidentally. If a tube is still needed to provide nutrition, it must be replaced.
Formula-related
Intolerance of the formula	Diarrhea, digestive upset, nausea, and vomiting	The formula causes intolerable digestive symptoms in up to 20% of people being fed through a tube and in 50% of those with a serious illness. These symptoms are more common when feedings are given in large amounts (called boluses) given several times a day rather than continuously over longer periods of time.
Diarrhea	Frequent, loose stools	Many formulas used in tube feeding contain sorbitol, which can cause or worsen diarrhea. When diarrhea occurs, many of the nutrients pass through the digestive tract without being absorbed.
Imbalances in nutrients	Abnormal levels of electrolytes Overview of Electrolytes Well over half of the body's weight is made up of water. Doctors think about the body's water as being restricted to various spaces, called fluid compartments. The three main compartments are... read more Abnormally high levels of blood sugar (hyperglycemia) Too much fluid in the body (volume overload)	Doctors regularly measure weight (to check for too much water) and blood levels of electrolytes, sugar, and other substances. They then adjust the formula as needed.
Other
Backward flow of the stomach's contents into the esophagus (reflux) Excess secretions in the mouth and throat	Inhalation (aspiration) of the formula into the lungs, which causes coughing and choking and increases the risk of infection such as pneumonia	If people have either of these problems, they may inhale the formula into the lungs even though the tube is placed correctly and the head of the bed is elevated.

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