What is OGT Enteral Feeding?
Yes, OGT feeding is a form of enteral feeding, which is any method of providing nutrition that uses the gastrointestinal (GI) tract. An orogastric tube, or OGT, is a thin, flexible tube that is inserted through the mouth, guided down the esophagus, and ends in the stomach. This allows for the direct delivery of liquid nutritional formulas, fluids, and medications into the stomach, bypassing the need for oral intake. The fundamental principle is that the digestive system, from the stomach downwards, is still able to function, making it the preferable feeding method over intravenous (parenteral) nutrition, which bypasses the digestive tract entirely.
The Different Types of Enteral Feeding
OGT is just one of several types of enteral feeding tubes, each chosen based on the patient's condition and the anticipated duration of feeding. The following are some common types:
- Nasogastric (NG) tube: A tube inserted through the nose into the stomach. It is generally used for short-term feeding, typically less than four to six weeks.
- Nasoduodenal (ND) and Nasojejunal (NJ) tubes: Tubes inserted through the nose that extend past the stomach into the small intestine. These are used when the stomach cannot tolerate feedings due to issues like poor gastric emptying or high aspiration risk.
- Gastrostomy (G-tube): A tube placed surgically or endoscopically through the abdominal wall directly into the stomach. This method is preferred for long-term enteral nutrition.
- Jejunostomy (J-tube): A tube inserted through the abdominal wall directly into the jejunum, a part of the small intestine. It is used when the stomach must be bypassed entirely.
- Gastrojejunostomy (GJ-tube): A single tube with two ports, one ending in the stomach and the other in the jejunum. This allows for both gastric decompression and jejunal feeding.
Indications for OGT Feeding
An OGT is typically used when a patient cannot take in sufficient nutrients orally, but is expected to only need feeding support for a short time. This tube is often the preferred choice for specific patient groups, such as those on mechanical ventilation, because the nasal passage is left unobstructed. Common indications for OGT feeding include:
- Impaired oral feeding or swallowing (dysphagia) due to neurological conditions like stroke or cerebral palsy.
- Increased nutritional requirements that cannot be met by oral intake, for example, in cases of burns or certain chronic illnesses.
- Patients with facial or oropharyngeal trauma.
- Conditions affecting the esophagus, such as strictures.
- Congenital anomalies in infants that hinder feeding.
The OGT Insertion and Administration Process
The OGT procedure requires a trained healthcare professional. The process involves careful steps to ensure safety and proper placement.
- Patient Preparation: The patient is positioned comfortably, typically in an upright or semi-recumbent position to use gravity to help with insertion and reduce aspiration risk.
- Measurement: The correct length of the tube is measured by assessing the distance from the mouth to the earlobe, and then to the midpoint between the xiphoid process and the navel.
- Insertion: The lubricated tube is gently passed through the patient's mouth and into the esophagus. A swallowing reflex can help guide the tube's passage, which is why non-nutritive sucking is used for infants.
- Placement Confirmation: Proper placement is crucial to prevent complications like aspiration. The most reliable method is using pH indicator strips to test gastric aspirate; a pH of 1-5 indicates correct placement in the stomach. An X-ray is also used for definitive confirmation. The old auscultation or "whoosh test" is not considered reliable and is discouraged.
- Administration: Feeding can be done via a syringe (bolus feeding) for intermittent delivery or a pump for a continuous, controlled flow, depending on the patient's tolerance.
OGT vs. NGT Feeding: A Comparison
While both are short-term enteral options, the choice between an OGT and a nasogastric tube (NGT) depends on the specific clinical situation. Both tubes have similar fundamental functions, but differ in key aspects.
| Feature | Orogastric Tube (OGT) | Nasogastric Tube (NGT) |
|---|---|---|
| Insertion Route | Through the mouth | Through the nose |
| Patient Suitability | Often preferred for mechanically ventilated patients or those with oral conditions. | Can be less comfortable for those with pre-existing respiratory issues. |
| Effect on Breathing | Does not obstruct the nasal airway, an important consideration for obligate nasal breathers like infants. | Can increase nasal airway resistance. |
| Security | More challenging to secure, with a higher risk of displacement. | Easier to secure with tape to the nose or cheek. |
| Risk of Complications | Higher risk of dislodgment and potential for oral trauma. | Potential for nasal irritation, sinusitis, and mucosal damage. |
| Feeding Effectiveness (Preterm Infants) | Some studies indicate a longer time to establish full enteral feeding. | Shorter time to achieve full enteral feeding in some studies. |
Benefits and Risks of OGT Enteral Feeding
Like any medical intervention, OGT feeding has associated advantages and disadvantages that are carefully weighed by the medical team.
Benefits
- Improved Nutritional Intake: Ensures that patients who cannot eat or drink orally receive sufficient calories and nutrients, preventing malnutrition.
- Enhanced Hydration: Provides a safe and effective way to deliver necessary fluids to prevent dehydration.
- Medication Administration: Facilitates the delivery of medications directly into the stomach, bypassing swallowing difficulties.
- Preserves GI Tract Function: By utilizing the digestive tract, it helps maintain gut integrity and function, which is often preferable to parenteral feeding.
- Reduces Nasal Obstruction: A significant advantage in mechanically ventilated patients or infants who are obligate nasal breathers, unlike an NGT.
Risks
- Aspiration: The biggest risk is aspiration, where gastric contents enter the lungs, potentially causing pneumonia. This risk is heightened if the tube is misplaced or if the patient experiences reflux.
- Tube Dislodgment: The tube can be accidentally removed or displaced, which is more common with OGTs than NGTs due to its oral placement.
- Discomfort and Trauma: The insertion and presence of the tube can cause discomfort in the mouth and throat, and forceful insertion carries a risk of esophageal perforation.
- Infection: Poor hygiene during administration or care can lead to microbial contamination and infection.
- Blockage: The tube can become clogged by thick formula or medication if not flushed properly.
Conclusion
In conclusion, OGT feeding is definitively a form of enteral feeding, delivering crucial nutritional support directly into the gastrointestinal tract via a tube through the mouth. It represents a vital option for patients, especially those who are mechanically ventilated or have nasal trauma, and cannot consume adequate nutrition orally. As a short-term intervention, it is favored for its benefits of using a functional digestive system. However, the procedure comes with risks like aspiration and dislodgment that necessitate careful insertion, confirmation of placement, and ongoing monitoring by trained healthcare professionals. The choice between an OGT and other feeding tube types is a clinical decision based on the patient’s specific condition, needs, and duration of required nutritional support.
For more information on enteral feeding and various feeding tube types, consult the guide on Enteral Feeding on the National Institutes of Health (NIH) website: Enteral Feeding - StatPearls - NCBI Bookshelf.
