What is a Feeding tube?

A feeding tube is a piece of medical equipment, generally made of plastic, to feed individuals who are unable to take food through the mouth securely. They bypass the chewing and swallowing procedure and deliver the food directly to the gut.

When are Feeding tubes necessary?

When a patient suffers from eating disorder, oral cancer or any complications where having food through the mouth becomes challenging, a feeding tube is used. Forced swallowing can end up with food in the ‘wrong pipe’, which can lead to serious illness.

Nutrients can be supplied as fluids through the , but food delivered to the gut through a feeding pipe is more effective than food delivered into the blood.

What are the types of feeding tubes?

There are multiple types of feeding tubes for a variety of medical conditions. The nature of dysphagia (difficulty in swallowing) determines the type of tube used. Some tubes are intended to be short term while some are long term.

Temporary Feeding Tube: these are short-term tubes and are inserted through the mouth or nose. The tube passes down the throat into the esophagus; the end of the tube rests in the stomach (G-tube) or the small intestine (J-tube). These tubes have a radiopaque tip, meaning the tip is detected in x-ray plates. This feature allows proper placement of the tube before use.

Temporary feeding tubes are two types:

• Nasal tube – inserted through the nose, down the throat, through the esophagus into the stomach or intestine. They are of three kinds: Nasogastric (NG), Nasoduodenal (ND) and Nasojejunal (NJ). Nasogastric tubes go down to the stomach, whereas, ND and NJ tubes (used by patients with chronic indigestion) go down to the intestine. It can remain in its place for a duration of four to six weeks after which it must be removed.
• Orogastric (OG) tube – like the NG tube, is inserted into the mouth, down the throat into the esophagus; the end rests in the stomach or intestine. It can remain in its place for two weeks after which it must be removed.

Permanent Feeding Tube: these are long term tubes and are inserted directly into the stomach or intestine through the abdomen. The process of tube insertion is called percutaneous endoscopic gastrostomy (PEG).

Permanent feeding tubes are also of two kinds:

• Gastric Tube (G tube) – this allows direct passage of food, fluid, and medication to the stomach. The tube is inserted through a stoma(incision) created on the left upper side of the abdomen. Children and adults who require enteral feeding for more than 3 months get a G-tube.
• Jejunostomy Tube (J tube) – Similar to the G-tube, this allows passage of food, fluid, and medication to the jejunum (the second part of the small intestine). The tube is placed through an incision in the abdomen lower than G-tube positioning. J-tubes are smaller than G-tube and limit the infusions to thin liquids and finely powdered medication.

How is a feeding tube placed?

Feeding tube placement may or may not require an anesthetic. Intensive care patients do not require additional sedation for tube placement.

An endoscope with a light and camera on the end is passed through the mouth and the esophagus to the stomach. Once the endoscope is in the stomach, the light allows a gastroenterologist to determine where to make the incision. Half an inch-long incision is made through which the feeding tube is passed.

Split bandages are used to secure the tubing tightly at the incision and reduce all possible leakages. The outer portion of the tube has a cap feature and can be opened during feeding.

How to remove the feeding tube?

• Temporary feeding tube removal – short term tube removal is quick and easy. The tube is cleaned of food and fluid residue using a large syringe (made for enteral cleaning). The tube is gently pulled out which requires a steady 3-5 seconds. An intact tube determines successful removal and is later discharged.
• Permanent feeding tube removal – a long term tube can be removed only if the patient regains the ability to eat and drink. The process is quick, and the pain is moderate. While a disposable towel is held near the site, the practitioner steadily and firmly pulls out the tube from the stoma. The removal process has a stinging sensation. The incision may require a stitch or just be cleanly dressed in sterile gauges.

Feeding Tube Removal Complications

• Aspiration: Gastric contents get inhaled into the lower airways; the most common complication and can lead to death due to aspiration pneumonia.
• Peristomal pain: Sufficient analgesics should be used to reduce stomal pain. The presence of pain even after an analgesic is a hint of clinical infection at the peristomal site.
• Site infection: Peristomal wound infection is common in 30% of enteral patients. Surgical debridement and intravenous antibiotics are available treatments for stomal infection.
• Buried Bumper Syndrome: Though very rare but is a life-threatening complication. A gastrostomy tube comes with an internal bumper and an external bumper to secure the tube placing. Buried Bumper Syndrome occurs when the internal bumper erodes into the skin and may get entirely buried with the fistula tract. Treatment involves the removal of the gastrostomy tube either by laparoscopy or endoscopy.

When to call a doctor?

Call for a doctor or at least a medical practitioner if:

• There are leaks around the tube.
• There is a blockage in the tube.
• The tube gets dislodged or comes out of the stoma.