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Tube Feeding

By

Sarah Lewis, PharmD

What is tube feeding?

Tube feeding, or enteral feeding, is the delivery of liquid nutrition through a small tube directly into the stomach or the first part of the small intestine. Tube feeding may be necessary for people who have difficulty swallowing or are unable to eat enough food to meet their needs.

Tube feedings can be temporary, as part of rehabilitation until a person can eat again, or long-term for chronic medical conditions requiring nutritional support. People with feeding tubes may still be eating and drinking some foods and liquids by mouth.

Tube feeding is only one method of supplementing the nutritional needs of people with various diseases, disorders and conditions. Discuss all of your nutritional options with your doctor to understand which options are right for you.  

Types of tube feeding

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The types of tube feeding include:

  • Gastrostomy (G) tubes are surgically inserted through the skin of the abdomen (belly) directly into the stomach.

  • Jejunal (J) tubes are surgically inserted through the skin of the abdomen (belly) directly into the jejunum (first part of the small intestine).

  • Nasogastric (NG) tubes are inserted through the nose into the stomach.

  • Nasojejunal (NJ) tubes are inserted through the nose into the first portion of the small intestine or jejunum.

Why is tube feeding performed? 

Your doctor may recommend tube feeding for diseases and conditions that affect your ability to swallow or take in enough food to meet your needs. These include:

  • Cancer including oral, esophageal and stomach cancer, and side effects from cancer treatment including mouth or throat sores, severe nausea, loss of appetite, and unintentional weight loss

  • Congenital (present at birth) conditions including abnormalities of the mouth, esophagus, stomach or intestines

  • Critical conditions including critically ill or injured patients requiring mechanical ventilation

  • Eating disorders including anorexia nervosa

  • Failure to thrive including an adult’s inability to maintain weight or a child’s inability to gain weight or grow appropriately

  • Gastrointestinal (GI) disorders including liver, pancreatic, and stomach disorders

  • Neurologic conditions including stroke, Alzheimer’s disease, and advanced dementia

  • Neuromuscular disorders including muscular dystrophy, spinal cord defects, cerebral palsy, and amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)

  • Prematurity including developmental delays and sucking and swallowing difficulties in premature infants

Who performs tube feeding?

A registered nurse (RN) or a doctor inserts a nasogastric (NG) feeding tube. 

Complex types of feeding tubes include nasojejunal (NJ) tubes, gastrostomy (G) tubes, and jejunal (J) tubes. Placement of these feeding tubes occurs in a radiology or surgery department in a hospital. Procedures are performed by the following specialists:

  • General surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions.

  • Radiologists specialize in using radiation and other imaging techniques to diagnose and treat a wide variety of conditions from broken bones and birth defects to cancer.

  • Interventional radiologists and vascular radiologists specialize in diagnosing and treating diseases using radiation and other imaging technologies.

How is a tube feeding performed?

Your feeding tube will be inserted in your hospital room, outpatient clinic, or office setting. Insertion of a nasogastric (NG) tube takes five to 10 minutes and generally involves these steps:

  1. Your provider will numb your throat with a spray that contains a local anesthetic.

  2. Your provider will insert a flexible, lubricated feeding tube through your nose and feed it into the stomach. You will need to swallow to help move the tube through your esophagus.

  3. Your provider will check placement of the tube by listening to your stomach with a stethoscope as a small amount of air is pushed into the stomach. An X-ray may be taken to check placement.

Insertion of a nasojejunal (NJ) tube, gastrostomy (G) tube, or jejunal (J) tube takes about 30 minutes to an hour in a radiology or surgery department in a hospital. The procedure generally includes these steps:

  1. You will dress in a patient gown and lie on a procedure table.

  2. Your team will insert an IV to provide fluids and medications.

  3. You will receive a medication (a light sedative) to make you drowsy and relaxed and possibly a pain medication. In some cases, you may receive deeper sedation or anesthesia, in which you are more relaxed and unaware of the procedure and may not remember it. Children and infants may receive general anesthesia for feeding tube placement.

  4. Your team will attach devices to monitor your vital signs.

  5. For a nasojejunal (NJ) tube, your doctor will insert the tube through your nose and feed it to its position in the first part of the small intestine.

  6. Your doctor will place your gastrostomy (G) tube or jejunal (J) tube using a laparoscopic surgical technique or using a percutaneous endoscopic gastrostomy (PEG) procedure through the skin.

  7. Your team may take X-ray or fluoroscopy images once the tube placement is complete in order to verify its position.

Will I feel pain?

Your comfort and relaxation is important to both you and your care team. If an IV is necessary for your tube placement, you may feel a brief pinch or prick when the IV is inserted. You may also feel pressure and movement if your feeding tube is inserted through your nose and a brief gagging sensation as it passes through the throat. This should pass quickly.

You will receive enough pain, local anesthetic, and sedative medications to stay comfortable. Tell your care team if you are uncomfortable.

What are the risks and potential complications of feeding tube placement?  

Complications after a feeding tube placement are uncommon, but any medical procedure involves risk and possible complications. Complications may become serious in some cases. Complications can develop during the procedure or your recovery. Risks and potential complications of a feeding tube placement include: 

  • Adverse reaction or problems related to sedation or medications such as an allergic reaction and problems with breathing

  • Bleeding of the surgical site or from the nose

  • Blockage, movement, or displacement of the tube

  • Infection

  • Inserting a feeding tube through the nose into the windpipe instead of the esophagus

  • Small risk of cancer due to radiation exposure. Your care team follows strict standards for X-ray techniques and will use the lowest amount of radiation possible to make the best images. Your doctor will generally not order an X-ray if you are pregnant due to the danger of radiation to an unborn child.

  • Soreness or discomfort of the abdomen (belly)

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and: 

  • Following all instructions for the proper care and use of the feeding tube

  • Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery

  • Informing your doctor or radiologist if you are nursing or if there is any possibility that you may be pregnant

  • Notifying your doctor immediately of any concerns such as bleeding, fever, or increase in pain

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my tube feeding?

You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome. 

You can prepare for a feeding tube placement by:

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Preparing for a feeding tube placement can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and ques