What is enteral feeding?
Enteral feeding, also known as tube feeding or enteral nutrition, is a medical procedure that provides nutritional support directly into the gastrointestinal (GI) tract. It is typically used for patients who cannot meet their nutritional needs by mouth but have a functional digestive system. The procedure involves inserting a soft, flexible tube through the nose, mouth, or an incision in the abdomen, which delivers specially prepared liquid formulas containing carbohydrates, proteins, fats, vitamins, and minerals.
Why are enteral feedings used?
Enteral feeding is a vital intervention for people with conditions that impair their ability to swallow, chew, or absorb nutrients. Conditions that may require enteral feeding include:
- Neurological disorders: Conditions like stroke, multiple sclerosis, and Parkinson's disease can impair the swallowing reflex.
- Head and neck cancers or injuries: These can make eating and swallowing difficult or unsafe.
- Critical illness or injury: Trauma, burns, or other severe illnesses can increase metabolic needs beyond what oral intake can provide.
- Gastrointestinal issues: Problems such as a narrowed esophagus or severe Crohn's disease may interfere with nutrient absorption.
- Severe eating disorders or failure to thrive: Conditions where a person is unable to consume enough calories to develop and grow.
Types of enteral feeding tubes
There are several types of enteral feeding tubes, with the choice depending on the intended duration of feeding and the patient's medical condition.
Short-Term Tubes (4–6 weeks or less)
- Nasogastric (NG) tube: The tube is inserted through the nose, down the esophagus, and into the stomach. NG tubes are common for short-term feeding.
- Nasojejunal (NJ) tube: The tube is passed through the nose and into the jejunum (the middle part of the small intestine). This is often used for patients with impaired gastric emptying.
Long-Term Tubes (over 4–6 weeks)
- Percutaneous Endoscopic Gastrostomy (PEG) tube: A tube is surgically or endoscopically inserted through the abdominal wall directly into the stomach. This is a long-term option for patients who require nutritional support for an extended period.
- Percutaneous Endoscopic Jejunostomy (PEJ) tube: Similar to a PEG, but the tube is placed directly into the jejunum. This bypasses the stomach and is used for patients who cannot tolerate feeds into the stomach.
Methods of administration
How the liquid formula is delivered depends on the patient's needs and the feeding tube's location. The main methods include:
- Bolus Feeding: Delivered as large, quick meals over 5–10 minutes, several times a day. This method mimics normal mealtime patterns and is typically done for tubes placed in the stomach.
- Continuous Feeding: Administers a slow, constant drip of formula over 8–24 hours using an electric pump. It is often used for patients who have intolerance issues with bolus feeding or have a tube placed in the small intestine, which cannot handle large volumes at once.
- Intermittent Feeding: A scheduled, timed drip that occurs over a few hours several times a day, allowing the patient more freedom than continuous feeding.
Enteral vs. Parenteral Feeding
It is important to distinguish between enteral and parenteral feeding, as they serve different purposes based on the patient's GI tract function. The key differences are summarized in the table below.
| Feature | Enteral Feeding | Parenteral Feeding |
|---|---|---|
| Delivery Route | Directly into the gastrointestinal (GI) tract via a tube. | Directly into the bloodstream via an intravenous (IV) catheter. |
| GI Tract Function | Requires a functional GI tract. | Used when the GI tract is not functional or needs to rest. |
| Nutrient Absorption | Relies on the body's natural digestive and absorptive processes. | Bypasses the digestive system entirely, delivering pre-digested nutrients. |
| Benefits | More physiological, lower infection risk, lower cost, and helps maintain gut integrity. | Provides nutrition when the GI tract is non-functional. |
| Risks | Aspiration pneumonia, tube blockages, and GI intolerance. | Higher risk of infection, metabolic complications, and expense. |
Common complications of enteral feeding
While highly effective, enteral feeding can lead to complications that require careful monitoring.
- Gastrointestinal complications: Diarrhea is the most common issue, potentially caused by the feeding formula or medication. Other problems can include nausea, bloating, and constipation.
- Aspiration pneumonia: This is a life-threatening complication where the feeding formula or gastric contents enter the lungs. It is a particular risk for patients with impaired swallowing reflexes.
- Tube-related issues: Blockages or accidental dislodgement of the feeding tube can occur. Routine flushing and proper securing of the tube can prevent these issues.
- Refeeding syndrome: In severely malnourished patients, the sudden reintroduction of nutrients can cause dangerous fluid and electrolyte shifts. This condition requires close monitoring and careful management of feeding rates.
Caring for someone on enteral feeding
Caring for a patient receiving enteral nutrition, whether in a hospital or at home, requires attention to detail to ensure safety and comfort.
- Positioning: Keep the patient's head of the bed elevated 30 to 45 degrees during feeding and for at least 30 to 60 minutes after to reduce the risk of aspiration.
- Hygiene: Practice proper hand hygiene before and after handling the feeding tube and equipment. Regularly clean the skin around the tube insertion site to prevent infection.
- Flushing the tube: Flush the tube with water before and after each feeding or medication administration to prevent blockages.
- Medication administration: Only use liquid medication or tablets that have been safely crushed and dissolved, and administer them individually.
- Monitoring: Monitor for signs of feeding intolerance such as nausea, vomiting, or abdominal distension. Regularly check the tube's position and the condition of the insertion site.
Conclusion
Enteral feeding is a critical medical intervention for delivering necessary nutrients to individuals who cannot eat safely or adequately by mouth but have a functional digestive system. The type of feeding tube and administration method are tailored to the patient's specific needs and condition. While offering significant benefits over parenteral nutrition by maintaining gut function and having a lower infection risk, enteral feeding requires careful management to prevent common complications. With a multidisciplinary approach involving healthcare professionals, patients can receive safe and effective nutritional support, ultimately improving their health outcomes and quality of life.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult a healthcare professional for diagnosis and treatment.
