What is enteral feeding?
Enteral feeding is a method of delivering nutrients directly to the gastrointestinal (GI) tract when a person cannot eat or drink enough to sustain themselves. This broad category of nutritional support can be delivered by mouth or, more commonly, through a feeding tube. Enteral nutrition is generally the preferred method of feeding over parenteral (intravenous) nutrition because it is safer, more effective, and helps preserve the natural function and integrity of the gut.
Enteral feeding is indicated for patients who have a functioning digestive system but are unable to safely consume adequate oral intake due to a variety of medical conditions. These conditions can range from neurological disorders that affect swallowing to head and neck cancers or severe malnutrition. A team of healthcare professionals, including doctors, nurses, and dietitians, works together to determine the most appropriate feeding plan for each patient.
Specific terminology: What is feeding via a gastric tube called?
Feeding via a gastric tube is specifically called gastrostomy feeding or gastric tube feeding. It is one of several methods within the broader term of enteral nutrition. A gastrostomy tube, often referred to as a G-tube, is a feeding tube inserted through a small incision in the abdomen directly into the stomach. This is typically used for long-term nutritional support, usually lasting longer than four to six weeks. A common method for inserting this tube is via a procedure called a percutaneous endoscopic gastrostomy (PEG), which is why the tube is also frequently called a PEG tube.
For short-term nutritional needs (typically less than four to six weeks), a different type of gastric tube is used. A nasogastric (NG) tube is a flexible tube that is inserted through the nose, down the esophagus, and into the stomach. This method is less invasive for insertion but is not meant for long-term use due to potential discomfort and irritation. Another term sometimes used for gastric tube feeding, especially when referring to the feeding of infants, is gavage.
Common types of enteral feeding tubes
- Nasogastric (NG) Tube: A temporary tube inserted through the nose into the stomach, used for short-term feeding or to decompress the stomach.
- Gastrostomy (G-tube) / PEG Tube: A long-term tube placed directly into the stomach through the abdominal wall, often inserted via an endoscopic procedure.
- Jejunostomy (J-tube): A long-term tube placed directly into the jejunum (the second part of the small intestine), used when feeding into the stomach is not tolerated.
- Gastrojejunostomy (GJ-tube): A dual-port tube that enters the stomach but extends into the jejunum, allowing for gastric decompression while feeding into the small intestine.
Methods of tube feeding administration
- Bolus Feeding: Administers formula in larger amounts several times a day, typically using a syringe. This method mimics the traditional meal schedule and is usually reserved for tubes that end in the stomach.
- Continuous Feeding: Uses a pump to deliver a slow, constant flow of formula over an extended period (8-24 hours). This is often used for patients with feeding tubes in their small intestine or those who can't tolerate large volumes of formula at once.
- Cyclic Feeding: A variation of continuous feeding, where formula is delivered over a specified time, such as overnight, to allow for greater mobility during the day.
Benefits and risks of enteral nutrition
| Feature | Benefits of Enteral Nutrition | Potential Risks/Disadvantages |
|---|---|---|
| Gut Function | Helps maintain the integrity and function of the digestive system. | Can cause gastrointestinal issues like diarrhea, constipation, bloating, or cramping. |
| Infection Risk | Significantly lower risk of infection compared to intravenous (parenteral) feeding. | Potential for infection at the tube insertion site (stoma) or aspiration pneumonia if formula enters the lungs. |
| Cost | Generally more affordable than parenteral nutrition over the long term. | Costs can include feeding formulas, pumps, syringes, and other supplies. |
| Patient Comfort | Long-term tubes (G-tubes) can be less visible and more comfortable than nasal tubes. | Nasal tubes can cause discomfort and irritation. Tubes can also become dislodged or clogged. |
| Metabolic Health | Mimics normal digestion and absorption, leading to better management of blood sugar and electrolytes. | Can cause metabolic complications, such as refeeding syndrome in severely malnourished patients if not started carefully. |
Indications for gastric tube feeding
Multiple medical conditions may necessitate the use of a gastric feeding tube, including:
- Dysphagia: Difficulty or inability to swallow, which can result from a stroke, multiple sclerosis, or other neurological conditions.
- Gastrointestinal Issues: Conditions like a narrowed esophagus or poor gastric emptying that prevent adequate oral intake.
- Head and Neck Cancers: Tumors or treatment-related side effects that make swallowing difficult or painful.
- Critical Illness and Trauma: Patients in a coma, on a ventilator, or recovering from severe injuries often require nutritional support through a tube.
- Severe Malnutrition: Individuals who are unable to eat enough to meet their high metabolic needs, such as burn patients or those with cystic fibrosis.
What to expect with a gastric tube
When a gastric tube is needed, the patient works closely with a healthcare team to manage the process. The insertion of a long-term G-tube via PEG is a minor procedure, often done on an outpatient basis. Patients may experience some soreness at the insertion site for a couple of days. For short-term NG tubes, insertion is done at the bedside and can be uncomfortable initially.
Ongoing care for a gastrostomy site involves daily cleaning to prevent infection and regular flushing of the tube to prevent blockages. Caregivers and patients receive training on how to manage the tube, administer feeds, and handle potential complications. High-quality, specialized liquid formulas are used for feeding, and medications can often be given through the tube as well.
Conclusion
In summary, feeding via a gastric tube is called gastrostomy feeding and is a specific form of enteral nutrition. The decision to use a gastric tube depends on the patient's underlying condition and the expected duration of nutritional support. While it can present challenges, such as potential complications and discomfort, it is a crucial tool for providing necessary nourishment and improving health outcomes for those who cannot eat safely or adequately. Working closely with a healthcare team is essential for ensuring safe and effective tube feeding and minimizing risks.
