Feeding tube: Difference between revisions

Feeding tube
Feeding tube
	A malnourished child with a feeding tube.
ICD-9-CM	96.35
MeSH	D004750
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Revision as of 23:46, 29 March 2012

A feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by swallowing. The state of being fed by a feeding tube is called gavage, enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. A variety of feeding tubes are used in medical practice. They are usually made of polyurethane or silicone. The diameter of a feeding tube is measured in French units (each French unit equals 0.33 millimeters). They are classified by site of insertion and intended use.

Types of feeding tubes

Nasogastric

A nasogastric feeding tube or NG-tube is passed through the nares (nostril), down the esophagus and into the stomach. This type of feeding tube is generally used for short term feeding, usually only 2 weeks maximum.

Gastric feeding tube

A gastric feeding tube (G-tube or "button") is a tube inserted through a small incision in the abdomen into the stomach and is used for long-term enteral nutrition. One type is the percutaneous endoscopic gastrostomy (PEG) tube which is placed endoscopically. The position of the endoscope can be visualized on the outside of the patient's abdomen because it contains a powerful light source. A needle is inserted through the abdomen, visualized within the stomach by the endoscope, and a suture passed through the needle is grasped by the endoscope and pulled up through the esophagus. The suture is then tied to the end of the PEG tube that will be external, and pulled back down through the esophagus, stomach, and out through the abdominal wall. The insertion takes about 20 minutes. The tube is kept within the stomach either by a balloon on its tip (which can be deflated) or by a retention dome which is wider than the tract of the tube.

Gastric feeding tubes are suitable for long-term use, though they sometimes need to be replaced if used long term. The G-tube can be useful where there is difficulty with swallowing because of neurologic or anatomic disorders (stroke, esophageal atresia, tracheoesophageal fistula), and to avoid the risk of aspiration pneumonia. However, in patients with advanced dementia or adult failure to thrive it does not decrease the risk of pneumonia.

Jejunostomy feeding tube

A jejunostomy feeding tube (J-tube) is a tube surgically inserted through the abdomen and into the jejunum (the second part of the small intestine). The procedure is called a jejunostomy.

Effectiveness

The effectiveness of feeding tubes varies greatly depending on what condition they are used to treat.

Advanced dementia and adult failure to thrive

There is strong evidence that feeding tubes do not help patients with advanced dementia or adult failure to thrive, and expert opinion^[1]^[2]^[3]^[4] recommends they not be offered to these patients. Studies have definitively proven to they do not prolong life, they do not decrease the risk of pneumonia, they do not improve wound healing, they do not help weight gain, and they do not help the patient regain any strength or functional ability such as walking or self-care. Patients with advanced dementia also often pull at their G tubes causing them to be dislodged, and frequently require physical restraints, such as tying their wrists to the bed, to keep this from happening.^[5]

Anorexia nervosa

Patients with anorexia nervosa or in some cases, bulimia nervosa or EDNOS may be tube fed if they are malnourished. This can be voluntary or in some cases where the patient is resistant to feeding under the force of the Mental Health Act. Patients may tamper with their feeds, which can interfere with the effectiveness of feeding.

ICU

Nasogastric tubes are often used in the intensive care unit (ICU) to provide nutrition to critically ill patients while their medical conditions are addressed. There is moderate evidence for use of feeding tubes in the ICU, especially if requiring mechanical ventilation for more than three days.

Neurologic disease and mechanical obstruction

There is at least moderate evidence for feeding tubes improving outcomes for chronic nutrition in patients with cancers of the head and neck, acute stroke while the patient undergoes rehab, and ALS.

Advanced cancer

There is no evidence that feeding tubes are beneficial in any way for patients who are losing weight with advanced cancer that is not directly related to problems swallowing due to the cancer, such as cancers of the throat or esophagus. Feeding tubes are frequently used in these populations, but studies to date have yet to prove that they are helpful.

Complications of feeding tubes

Gastric feeding tubes have a variety of complications that can occur, though the overall rate of complication is about 1%.

As feeding tubes are placed as a procedure that punches a hole in the stomach and skin, this can lead to leaking of contents into the abdomen causing severe infection and death. This is a rare, but serious complication.

The most frequent complication is irritation around the site of the insertion, generally caused by stomach acid and feedings leaking around the site. Barrier creams, dressings, and frequent cleaning is generally recommended.

Especially in advanced dementia, patients can pull at the feeding tubes causing them to be dislodged and requiring a hospitalization to replace them.

Feeding tubes may become clogged or occluded if not flushed with water after each feeding. A clogged tube may need to be replaced.

Withdrawal

Tube feeding, like all medical treatments, can be declined or stopped, especially in the setting of a terminal illness where its use would not alter the ultimate outcome. Alternatively, nutrition can be withheld and the tube used only for hydration and medicine if desired.

Some patients or families will opt for a "time limited trial" of feeding through a tube, but after a set time period if the individual is not improving feedings are stopped and the goals of care are refocused to comfort measures.

External links

References

^ http://jama.ama-assn.org/content/282/14/1365.short
^ http://archinte.ama-assn.org/cgi/content/abstract/157/3/327
^ http://archinte.ama-assn.org/cgi/content/abstract/161/4/594
^ http://www.drplace.com/Feeding_Tubes_in_Patients_with_Severe_Dementia.16.28273.htm
^ Peck A, Cohen CE, Mulvihill MN. Long-term enteral feeding of aged demented nursing home patients. PMID 2123217 J Am Geriatr Soc. 1990;38:1195–8

[1] ttp://jama.ama-assn.org/content/282/14/1365.short

[2] ttp://archinte.ama-assn.org/cgi/content/abstract/157/3/327

[3] ttp://archinte.ama-assn.org/cgi/content/abstract/161/4/594

[4] ttp://www.drplace.com/Feeding_Tubes_in_Patients_with_Severe_Dementia.16.28273.htm

[5] Peck A, Cohen CE, Mulvihill MN. Long-term enteral feeding of aged demented nursing home patients. PMID 2123217 J Am Geriatr Soc. 1990;38:1195–8

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 ===Anorexia nervosa===
-Patients with anorexia nervosa or in some cases, bulimia nervosa may be tube fed if they are malnourished. This can be voluntary or in some cases where the patient is resistant to feeding under the force of the Mental Health Act.  Patients may tamper with their feeds, which can interfere with the effectiveness of feeding.
+Patients with anorexia nervosa or in some cases, bulimia nervosa or EDNOS may be tube fed if they are malnourished. This can be voluntary or in some cases where the patient is resistant to feeding under the force of the Mental Health Act.  Patients may tamper with their feeds, which can interfere with the effectiveness of feeding.
 ===ICU===