Is tube feeding considered enteral nutrition? A complete guide

Over 340,000 Americans use tube feeding each year to receive their nutrition. The answer is yes: tube feeding is considered enteral nutrition, a method that uses the gastrointestinal tract to deliver essential nutrients when a person cannot eat or swallow sufficiently.

Quick Summary

Tube feeding is a specific method of delivering enteral nutrition, which involves providing nutrients directly to the gastrointestinal tract via a tube. It is used when oral intake is insufficient or unsafe.

Key Points

• Clear Distinction: Tube feeding is a method of delivering enteral nutrition, not a separate category entirely, as it uses the GI tract.

• Gut-Dependent: Enteral nutrition, including tube feeding, relies on a functioning gastrointestinal tract, unlike parenteral nutrition, which bypasses it entirely.

• Multiple Access Points: Feeding tubes can be placed through the nose for short-term use (NG, NJ) or surgically for long-term support (G, J, GJ).

• Benefits Over IV Feeding: Compared to intravenous (parenteral) feeding, enteral nutrition is safer, cheaper, and helps preserve gut health and function.

• Comprehensive Care: Proper tube feeding management includes scrupulous hygiene, regular tube flushing, and monitoring for potential complications like clogging, infection, or intolerance.

• Patient-Specific Approach: The type of tube, formula, and feeding schedule are all customized based on the patient's individual needs, diagnosis, and nutritional goals.

Understanding Enteral Nutrition

Enteral nutrition (EN) is a broad term that refers to any method of feeding that utilizes the gastrointestinal (GI) tract. This can range from a regular diet taken by mouth to specialized liquid formulas delivered through a feeding tube. The core principle of enteral nutrition is that the digestive system remains the pathway for nutrient absorption, which is crucial for maintaining gut integrity and immune function.

The Different Forms of Enteral Feeding

Enteral feeding can take several forms, all of which depend on a functional GI tract:

• Oral Supplements: Liquid nutritional formulas, shakes, or powders that can be consumed by mouth to supplement a regular diet.
• Tube Feeding: The delivery of liquid nutrition directly into the stomach or small intestine via a flexible tube.

The Clear Answer: Is Tube Feeding Enteral Nutrition?

To answer the question directly, yes, tube feeding is a type of enteral nutrition. Tube feeding is a specific, and often more advanced, method of ensuring that a person receives adequate nutritional support when they are unable to do so orally. This might be due to swallowing difficulties, unconsciousness, or a medical condition affecting the mouth, throat, or esophagus. For the gastrointestinal tract to function, it must be used. When oral intake is impossible, tube feeding becomes the preferred method for nourishing the body.

Types of Tube Feeding (Enteral Access Devices)

The type of feeding tube used depends on the patient's condition, the anticipated duration of therapy, and the specific site required for nutrient delivery.

• Nasally Inserted Tubes (Short-Term Use):
  • Nasogastric (NG) tube: A tube inserted through the nose into the stomach. It's typically used for short-term feeding, generally less than four to six weeks.
  • Nasojejunal (NJ) tube: A tube inserted through the nose, extending past the stomach into the jejunum (the middle part of the small intestine). This is used when the stomach cannot tolerate feedings.
  • Nasoduodenal (ND) tube: Similar to an NJ tube, but the tip ends in the duodenum, the first part of the small intestine.
• Surgically Placed Tubes (Long-Term Use):
  • Gastrostomy (G-tube): A tube placed directly through a small incision in the abdomen into the stomach. It is suitable for long-term nutritional support.
  • Jejunostomy (J-tube): A tube placed directly into the jejunum. It is used when stomach feeding is not an option.
  • Gastrojejunostomy (GJ-tube): A tube that provides access to both the stomach and the jejunum through a single incision, allowing for both stomach venting and jejunal feeding.

Enteral Nutrition vs. Parenteral Nutrition: A Comparison

While tube feeding is a form of enteral nutrition, it is critical to differentiate it from parenteral nutrition. Parenteral nutrition bypasses the GI tract entirely, delivering nutrients intravenously into a patient's bloodstream.

Feature	Enteral Nutrition (Including Tube Feeding)	Parenteral Nutrition (PN)
Delivery Route	Gastrointestinal (GI) tract via mouth or feeding tube	Intravenous (IV), directly into a vein
GI Tract Function	Requires a functioning GI system for digestion and absorption	Bypasses the entire digestive system
Risk of Infection	Lower risk, especially infection-related complications	Higher risk of infection, especially bloodstream infections
Cost	Generally less expensive	Considerably more expensive
Key Benefit	Maintains gut function, barrier integrity, and natural immune responses	Provides nutrition when the GI tract is non-functional
Common Complications	Diarrhea, constipation, tube clogging, aspiration	High blood sugar, infections, blood clots

Who Requires Tube Feeding?

Tube feeding is necessary for a wide range of patients who cannot meet their nutritional needs through oral intake alone, but who still have a functional digestive tract. Common conditions include:

• Dysphagia: Difficulty or inability to swallow, often due to a stroke, neurological disorder like Parkinson's or multiple sclerosis, or head/neck injury.
• Cancers: Especially head, neck, and esophageal cancers that can make swallowing painful or impossible.
• Gastrointestinal Disorders: Such as severe Crohn's disease, short bowel syndrome, or other conditions that impede the ability to consume enough nutrients.
• Critical Illness: Patients who are comatose, on a ventilator, or have severely increased nutritional needs due to burns or major trauma.

Caring for a Patient on Enteral Tube Feeding

Proper care is essential to ensure the safety and effectiveness of enteral tube feeding and prevent complications.

• Hygiene: Maintain strict hand hygiene before handling the tube and formula to prevent infections. The insertion site for surgically placed tubes must also be kept clean and dry.
• Tube Patency: Flush the feeding tube with water before and after each feeding and medication administration. This prevents clogging and keeps the patient hydrated.
• Positioning: Keep the patient's head elevated at a 30 to 45-degree angle during and for at least an hour after feeding to minimize the risk of aspiration.
• Monitoring: Closely monitor for common complications such as nausea, diarrhea, constipation, bloating, or signs of infection at the tube site. A dietitian plays a key role in monitoring nutritional status and adjusting the feeding plan.

Conclusion: The Role of Tube Feeding in Enteral Nutrition

Tube feeding is unequivocally a form of enteral nutrition, distinguished by its delivery method through a tube rather than oral consumption. This crucial medical therapy allows individuals with functional GI tracts, but who are unable to eat, to receive the vital nutrients they need for healing and recovery. By understanding the different types of access devices and the key distinctions between enteral and parenteral nutrition, both patients and caregivers can better navigate the process. Ultimately, tube feeding serves as an effective and often life-sustaining means to ensure nutritional requirements are met, demonstrating its vital role within the broader spectrum of enteral nutrition.

Frequently Asked Questions

What is the key difference between enteral and parenteral nutrition?

The key difference is the route of delivery. Enteral nutrition uses the gastrointestinal tract (via a tube or mouth), while parenteral nutrition bypasses the digestive system and delivers nutrients intravenously, directly into the bloodstream.

Why is enteral nutrition generally preferred over parenteral nutrition?

Enteral nutrition is often the preferred choice because it is less expensive, carries a lower risk of infection, and helps to maintain the function and health of the gastrointestinal tract.

For how long can a patient use a tube for enteral feeding?

The duration varies. Nasally inserted tubes are for short-term use (less than 4-6 weeks), whereas surgically placed tubes like a G-tube or J-tube are used for long-term nutritional support, sometimes for years.

Can a person still eat and drink by mouth while on tube feeding?

Yes, in many cases. Tube feeding is often used to supplement what a person can eat or drink orally, especially if they are not consuming enough calories or fluids to meet their nutritional needs.

What are some common complications of tube feeding?

Common complications include tube clogging, infection at the insertion site (for surgical tubes), diarrhea, constipation, nausea, and potential aspiration of formula into the lungs.

What is a nasogastric (NG) tube used for?

An NG tube is a thin, flexible tube inserted through the nose, down the esophagus, and into the stomach. It is primarily used for short-term enteral feeding.

What conditions might require tube feeding?

Many conditions necessitate tube feeding, such as difficulty swallowing (dysphagia) from a stroke or neurological disorder, head and neck cancers, severe GI diseases like Crohn's, and critical illness or coma.