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 receiving food through your veins.

Why are people fed by a tube?

There are many reasons why you may not be able to eat in the usual way. When you cannot take in enough food you are in danger of malnutrition.

Sometimes people are so ill that they are too sick to eat. People more likely to need tube feeding include those with:

• AIDS
• burns
• cancer
• kidney problems
• liver problems
• lung problems
• pancreas problems
• stomach problems
• surgery.

Some people have trouble swallowing. If swallowing is not normal, you may breathe food into the lungs. Food in the lungs can cause pneumonia. People in a coma need to be fed by tube if they are to remain alive.

Sometimes the problem is not related to swallowing or digestion. Some people will not eat or do not take in enough food. This can happen as a result of dementia, depression, and other chronic conditions.

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

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

How does tube feeding work?

A dietitian or nutritionist figures out which nutrients (vitamins, minerals, fluids) and how many calories the person needs each day. Then he or she selects the right formula to meet those needs. Some examples of formulas are Ensure, Glucerna, and Pulmocare. Blended food formulas may be made at home. These cost less than ready-made formulas.

Formulas may be given in 3 ways:

• Continuous feeding. A small amount of formula is given without interruption over 12 to 24 hours.
• Intermittent feeding. The total amount of formula needed in a day is divided into 3 to 6 feedings. Each feeding is then given over 60 to 90 minutes.
• Bolus feeding. A large amount of formula is given by syringe in 15 to 30 minutes. This method faster and uses less equipment, but can cause problems such as diarrhea.

It may be possible to continue regular eating by mouth while tube feedings ensure adequate nutrition.

How is tube feeding different from parenteral nutrition?

Parenteral nutrition is another way people receive food when they cannot eat. It is a special liquid food mixture given into the blood with a needle through a vein. It bypasses the person's 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.

What types are tubes are used?

Small plastic or silicon tubes are used. Tubes are changed whenever they become plugged or at regular scheduled intervals.

Tubes can be inserted in several places along the gastrointestinal tract:

• 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 the tube uncomfortable, and it is easy to dislodge accidentally. These tubes may be used when tube feeding is needed for only a short time (days or weeks).
• Percutaneous endoscopic gastrostomy (PEG): A small cut is made in the skin of the abdominal wall. Using a lighted instrument (endoscope) passed through the mouth into the esophagus, the feeding tube is placed into the stomach. A balloon or cap in the stomach holds the tube in place. These tubes are placed when tube feeding is needed for months or more.
• Jejunostomy: The tube to be used for feeding is surgically placed in the middle section of the small intestine called the jejunum. These tubes are placed when tube feeding is needed for a long time, usually permanently.

Are there any problems with tube feeding?

Problems fall into 4 categories:

• The digestive system may not work properly. Diarrhea is the most annoying complication. It can usually be improved by changing formulas or giving less at one time.
• 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, resulting in 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 "normal people." There may have to be extra equipment in the home for the feedings. You may need help in preparing or giving the feedings and may feel dependent on another person.

  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 tube fed?

Any competent adult (someone who is capable of making decisions for himself or herself) can accept or refuse tube feeding. Once such treatment is started, a competent adult can decide to stop the treatment at any time. When an adult cannot make his or her own decisions, the doctor turns to the family, legal guardian, or person appointed in a healthcare power of attorney to make these decisions.

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