If you stop to think about it, it’s pretty amazing how we get energy into our bodies. For most of us, we ingest calories orally by eating (hopefully nutritious and delicious) food and drink. These items get ground up by chewing, the first step in a complex process of digestion. Then, as we swallow, our mashed-up victuals travel down the esophagus and into the stomach where they’re liquefied. This slurry then passes into the intestines, which extract the nutrients we need from the food. Waste continues on down the colon and exits via the anus. It’s a well-designed system that relies on a combination of gravity and a host of precise muscle contractions to function properly.
So what happens if a person can’t — for any number of reasons — complete one of the many steps that need to occur for food to become energy? For some people, chewing and swallowing become difficult or impossible. For others, digestive disorders make extracting nutrition more challenging. For any of these individuals, placing a feeding tube might be a good short- or long-term solution to maintain weight, energy levels and bodily function. Faced with the prospect of having one implanted, here are the kinds of questions patients might ask:
— What are feeding tubes?
— What are the types of feeding tubes?
— How are feeding tubes placed?
— Who needs feeding tubes?
— What should I expect from tube feeding?
What Are Feeding Tubes?
Dr. Yatin Mehta, co-director of the division of critical care medicine at Geisinger in Danville, Pennsylvania, says feeding tubes are “used routinely for administration of medication and nutrition in anybody who can’t safely take these things orally.” For example, if someone is on a mechanical ventilation machine, “by default they would have a feeding tube because they would not be able to swallow,” because the ventilation tube is occupying the throat and preventing oral ingestion of food, drink or medication. Patients who’ve lost muscle tone or function in the face and throat may not be able to chew and swallow food normally and need a feeding tube.
[See: What to Eat, Drink and Do to Relieve Constipation.]
In other situations, patients with poor bowel motility, meaning limited or nonexistent contraction of the muscles that move items through the gastrointestinal tract, might need a feeding tube. This can be caused by a variety of disorders and conditions from gastroesophageal reflux disease, obstructions in the gut, gastroparesis (a disorder in which the stomach takes too long to empty), irritable bowel syndrome and inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis.
Providing nutrition isn’t the only way feeding tubes can be used, Mehta says. In patients with intestinal obstructions, a feeding tube can be inserted and used to suction out the obstruction and decompress the stomach and/or intestines. “In other situations where someone needs lavage, or a washing out of the stomach, feeding tubes can be inserted.” Lavage may be used to address “drug overdose where medication is sitting in the stomach (that needs to be removed) or if there’s suspicion of a GI bleed. We can put the feeding tube in and lavage out the contents of the stomach looking for blood.”
Feeding tubes are also common for patients recovering from surgery and those who cannot swallow safely, such as may occur after a severe stroke. Mehta says “about 90 percent of patients only require a feeding tube temporarily. Usually the underlying issues can be resolved and they can go back to eating the traditional way.” In the meantime, “feeding tubes are just another way to get food and fluid hydration into the body,” says Traci Nagy, founder and executive director of the Feeding Tube Awareness Foundation, a non-profit that aims to support parents of tube-fed children while raising awareness of tube feeding as a lifesaving medical intervention.
What Are the Types of Feeding Tubes?
Generally speaking, there are two types of feeding tubes — those that are inserted through the nose and those that are inserted directly into the abdomen. Within those two broad categories are five types of feeding tubes:
— Nasogastric (NG) tubes. NG-tubes are threaded through the nose down to the stomach and are intended for short-term feedings, usually one to six months. They do not require surgical placement and can be inserted relatively easily and removed just as easily, which can be a challenge for children who may find them irritating and pull them out.
— Nasoduodenal (ND) tubes. Similar to NG-tubes, ND-tubes pass through the nose but they’re longer, going past the stomach and into the first segment of the small intestine, called the duodenum. They are also usually intended to be short-term solutions, generally for one to six months, and can be placed without surgery, but require a skilled clinician to ensure the tube reaches the duodenum.
— Nasojejunal (NJ) tubes. NJ-tubes are nearly the same as ND-tubes, passing through the nose and into the intestine, but they’re a little longer again, bypassing both the stomach and the duodenum and terminating directly in the small intestine. They’re intended for people who can’t tolerate feedings into the stomach and can be placed and removed without surgery. However, like ND-tubes, these tubes need to be placed by a trained clinician to ensure they’re located properly in the intestine.
— Gastric or Gastrostomy (G) tubes. The Feeding Tube Awareness Foundation reports that “G-tubes are the most common type of feeding tube. They are placed surgically or endoscopically directly through the skin and into the stomach.” They’re best suited for people who need longer-term tube feeding, generally three months or more. Sometimes called percutaneous endoscopic gastrostomy tubes, PEG-tubes are commonly used medical devices that some people are able to manage at home on their own.
— Gastrojejunal (GJ) or Transjejunal tubes. GJ-tubes are similar to G-tubes in placement — they’re surgically or endoscopically inserted through the skin into the abdomen. These devices typically have two feeding ports — one that extends into the stomach and a second into the small intestine, which can help patients who can’t tolerate gastric feeding receive the nutrition they need. These are more complicated tubes that typically require the assistance of an interventional radiologist who uses imaging technology such as X-ray guidance to place the feeding tube accurately.
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How Are Feeding Tubes Placed?
Feeding tube placement depends largely on the condition the patient is dealing with. For patients who are having temporary difficulty swallowing caused by conditions that are expected to improve, such as post-surgical recovery, a temporary nasal placement is more likely. Mehta says patients who are on mechanical ventilation typically have the tube placed orally, using the ventilation tube as the access point. “If you’re not mechanically ventilated, the default placement is through the nose. Even though the insertion through the nose might be uncomfortable, it’s a lot better tolerated,” and it’s relatively easy to place.
The patient is usually awake for nasal feeding tube placement procedures, which involve simply threading the tube through the nose and down the throat into the stomach, duodenum or intestine. Mehta says the doctor will lubricate the passageway and talk the patient through the procedure. The patient is usually asked to assist during the placement. “We ask them to try to swallow as if they were swallowing food. The patient is alert and placed in an upright position,” to allow a straighter path to thread the tube into the stomach.
In more complicated or surgical placement procedures, the doctor may use imaging technology such as an X-ray to guide the placement. These procedures would typically be carried out while the patient is under general anesthesia and are usually intended for more permanent placement of a feeding tube.
For those who need tube feeding because of a more complex or progressive disease like Amyotrophic Lateral Sclerosis or advanced Alzheimer’s, a permanent or surgical placement may be a better option. Dr. Volkan Granit, a neurologist and medical director for the ALS Clinical and Research Center at the University of Miami in Florida, says tube feeding may become necessary for these patients because of how the disease progresses. “In ALS, many muscles become weak, including those muscles we use to swallow, breathe, move, etc. At some point for many patients, swallowing becomes an issue.”
Signs it might be time to consider moving to tube feeding include slurping while eating, aspirating liquids (breathing them into the lungs which can lead to dangerous infections or pneumonia) and weight loss. “Eventually people can’t maintain adequate nutrition safely, and patients lose a lot of weight,” Granit says. This weight loss is “inversely related to survival. Once people cannot swallow safely, nutrition and feeding becomes a chore” that may take much longer than it used to. This can be frustrating, causing people to skip eating or drinking all together, which can lead to dehydration, constipation and weight loss.
Who Needs Feeding Tubes?
Tube feeding presents a viable option to any patient who’s having trouble eating or drinking to bypass the whole swallowing issue, also called dysphagia, and get the nutrition they need. Feeding tubes are also critically important for delivering medicine to people who can’t digest it normally or otherwise wouldn’t be able to ingest it orally. “By inserting a tube in the stomach wall and feeding using that tube, patients can maintain hydration and calorie intake and maintain some sort of life quality,” Granit says. Depending on the situation, a patient may be presented with the option of tube feeding after about two weeks to a month of severe difficulty eating normally.
While tube feeding is often associated with aging and end of life, it’s actually a common solution for a range of problems you can encounter at any stage in life. Nagy says that about a half million people in the U.S. are estimated to rely on feeding tubes, with nearly half of them being children and babies. Often these are short-term solutions to problems such as premature birth that will resolve in time through simple growth and development.
However, some people may need a feeding tube for life. Many genetic, endocrine, metabolic, immune and other conditions can lead to a child needing a feeding tube for some period of time. The Feeding Tube Awareness Foundation lists more than 350 specific disorders that may require tube feeding, including Down syndrome, autism, brain tumors, cancers, cerebral palsy, heart problems, growth hormone deficiencies, cystic fibrosis, mitochondrial diseases, poor suck response in nursing babies and severe food allergies.
[See: Pharmacist-Recommended Stomach and GI Products.]
What Should I Expect From Tube Feeding?
Granit says a nutritionist works with patients put on feeding tubes to calculate their caloric needs based on a number of factor, including current weight and energy expenditure. As long as a food item is liquefied, it can theoretically be administered via a feeding tube, and while some people might opt for a shake or formula blend, others like to use whole foods to construct a meal that’s then liquefied in a blender and administered via the tube. Talk with your doctor about your or your child’s specific needs and preferences.
Some patients may be able to manage their own feeding; others may need the help of a caregiver or medical professional, depending on the severity of their condition and comorbidities. In the case of a baby or child who needs tube feeding, parents may be called on to handle the day-to-day administration of feedings. For these people, Nagy notes that “there’s a lot to learn, but I think the biggest thing that parents need to know is that they’re not alone in doing this.” Many children require this sort of help for some period of time, and there is support available. “The internet is a magical place” for connecting parents coping with the challenges of tube feeding a child. She says although some people may fear tube feeding or not understand its purpose, it’s “about enabling (patients) to live life and manage their medical conditions. It’s life-enabling and there’s a positive side,” to tube-feeding.
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What to Know About Feeding Tube Placement originally appeared on usnews.com
