Tube Feeding (Enteral Nutrition)

What is tube feeding (enteral nutrition)?

Tube feeding (enteral nutrition) uses a feeding tube to supply nutrients and fluids to your body if you can’t safely chew or swallow. Feeding tubes are soft, flexible plastic tubes through which liquid nutrition travels through your gastrointestinal (GI) tract. Healthcare providers also sometimes administer medicines through feeding tubes.

Think of a feeding tube as providing added access to your digestive system. If you have a condition that prevents food from traveling the traditional route through your GI tract — from mouth to esophagus (food tube) to stomach to small intestine — a feeding tube can help. Depending on where the tube ends, it delivers nutrition directly to your stomach (which stores and digests food) or small intestine (which absorbs nutrients).

Types of feeding tubes

Healthcare providers usually recommend feeding tubes that go in through your nose and down into your stomach or small intestine if you’ll need one for less than four to six weeks. Or, they may recommend a tube that goes in through your nose to see if your body can tolerate the feeding tube formulas. Types include:

• Nasogastric (NG) tube: The tube travels from your nose to your stomach.
• Nasoduodenal (ND) tube: The tube travels from your nose to the first part of your small intestine called the duodenum.
• Nasojejunal (NJ) tube: The tube travels from your nose to the second part of your small intestine called the jejunum.

Healthcare providers may recommend a more semi-permanent placement of tubes through your abdominal wall to access your stomach or small intestine directly. This is usually if you’ll need tube feeding longer than four to six weeks. Types include:

• Gastric or gastrostomy tubes (G-tubes): The tube goes directly into your stomach.
• Jejunostomy tubes (J-tubes): The tube goes into the second part of your small intestine called the jejunum.
• Gastrostomy-jejunostomy tube (GJ-tube): The tube goes into your stomach and passes through into your jejunum. These tubes have a G and a J port. The G port drains stomach fluids and allows providers to give medicines. The J port is used for feeding.

Why would someone need a feeding tube?

Your healthcare provider may recommend enteral nutrition if you aren’t getting the nutrition you need by mouth. You may need enteral nutrition if you have limited ability to chew or swallow (dysphagia).

Feeding tubes help support your metabolism and your overall digestive health.

Conditions that may cause you to need a feeding tube include:

• Severe eating disorders.
• Head and neck cancers or an injury that makes swallowing difficult.
• Gastrointestinal issues such as a narrowed esophagus or dysmotility (condition where the muscles and nerves in your digestive system don’t work as they should).
• Conditions that interfere with your ability to absorb nutrients (like severe Crohn’s disease or celiac disease.
• Recent surgery or medical illness that’s affected your ability to swallow.
• Neurological disorders, including stroke and paralysis.
• Unconsciousness (being in a coma).

Healthcare providers sometimes recommend tube feeding as a part of hospice care to help people at the end of life stay more comfortable. Some people (or their families) decide against tube feeding. In this instance, tube feeding is a highly personal decision that you should discuss with your healthcare provider.

What should I expect from tube feeding?

Your experience will depend on the type of feeding tube you get and why you need it. Your care team may take total responsibility for feedings and cleaning your feeding tube while you’re in the hospital. If you go home with it, you (or your caregivers) may need training on how to use and care for it. You may also need help setting up the equipment to use the tube at home.

Feeding tube placement

Healthcare providers usually insert feeding tubes while you’re in the hospital, but you may continue to use one at home. Tube feeding provided at home is called home enteral nutrition (HEN).

Some placement procedures can happen at your bedside. But if you’ll need a feeding tube for more than a month or so, you’ll need an in-hospital procedure to insert the tube. For these procedures, plan to fast (no eating or drinking) for at least eight hours. You’ll also need to stop blood-thinning medications (anticoagulants), like aspirin, for a while before the procedure. You’ll receive anesthesia and sedation, so you won’t feel pain. Procedures usually take half an hour.

Healthcare providers may insert the tube:

• Nasally: This procedure can happen at your bedside. Using image guidance, your provider will gently insert the tube into your nose and maneuver it through your throat and esophagus until it reaches your stomach. They’ll lubricate the tube and give you an anesthetic to make the procedure painless. They may ask you to sip water through a straw during the procedure to help encourage the tube downward.
• Endoscopically: Your provider will use a long, flexible instrument with a camera (endoscope) to help place the feeding tube. They’ll send the endoscope through your mouth and esophagus until it reaches your stomach. The camera lets them see where to make the tiny cut (incision) into your abdomen to insert the feeding tube. Types of feeding tube placement that use an endoscope include percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic gastrojejunostomy (PEG-J).
• Radiologically: Your provider will use X-rays to help them see where they should cut to insert the feeding tube. Types of feeding tube placement that use X-rays include radiologically inserted gastrostomy (RIG) and percutaneous radiologic jejunostomy (PRJ).
• Surgically: Your provider may perform open surgery, which requires a larger cut into your abdomen, or they may insert the feeding tube using laparoscopy. During a laparoscopy, your provider makes a few tiny cuts into your abdomen. They insert an instrument with a camera (laparoscope) to view your organs. They then insert the feeding tube using the other cuts.

Ask your healthcare provider about the method they’ll use to insert the feeding tube, so you know how to prepare and what to expect.

Using a feeding tube

Some feeding tubes use a syringe or pump to send liquid nutrition from a bag into your body. Other feeding tubes connect to bags that are raised on a pole or hook. Gravity sends the liquid nutrition down through the tube when it’s time to eat.

When you eat depends on various factors, including the type of feeding tube you have. Tube feedings may be:

• Only at mealtimes: This is called bolus feedings. You’ll receive liquid nutrition through the feeding tube during those times of day when you’d typically eat. The upside of bolus feedings is that you eat with regularity, like you would without a feeding tube. Bolus feeding is typically only done with tubes in your stomach, since your stomach naturally stores food and can handle the larger volume.
• Continuous: You’ll need to receive constant, small amounts of nutrition daily if your feeding tube is in your small intestine (duodenum or jejunum). This is because your small intestine isn’t meant to hold large volumes of food at a time.

Your healthcare provider will help you determine the type of formula and how much you need to ensure you’re getting the right amounts of fluids, vitamins, minerals and calories.

Many formulas are available with different concentrations of calories and specific nutrients, like proteins, fats and carbohydrates. Some formulas are specific for certain diseases, such as kidney diseases. Your provider may change the formula based on your tolerance and nutrition needs over time.

They can also advise you on how to receive enteral nutrition safely. For example, they may advise you to sit at a 45-degree angle during feedings and a few hours afterward to prevent complications, like aspiration pneumonia. With aspiration pneumonia, the formula slips into your windpipe and lungs, causing an infection. The way you position your body can prevent this.

Never insert any carbonated beverages into your feeding tube.

Caring for a feeding tube and the insertion site

You’ll need to care for the feeding tube to prevent clogs and clean the skin around the feeding tube to prevent infections.

To care for the insertion site:

• Wash it with soap and water at least once daily but more if you have drainage. You may need to contact your provider if you have drainage. They can provide gauze to help absorb the drainage or barrier creams to help protect your skin.
• Dry the area with a clean cloth between cleanings to discourage bacterial growth. (Bacteria grow in warm, moist environments.)
• Wipe away any crust that forms on a nasogastric (NG) tube (the kind that goes in your nose).
• Alert your provider immediately if you notice signs of an infection (warmth, redness, pain, swelling or pus).

To care for the tube:

• Flush your feeding tube regularly. Flush your tube with warm water before and after feedings to prevent clogs. Flush it before and after receiving medicine through your feeding tube. It’s important to flush it even on days when you’re not using it to eat or take medicines, so you’re keeping it clear. Your provider will demonstrate how to flush your feeding tube before you leave the hospital.
• Have your feeding tube changed regularly. It’s important to have the tube changed regularly to ensure it holds up and works as it should. Some of the tubes with harder plastic at the end need to be changed every year. Other tubes with balloons at the end need to be changed every three to six months. Ask your healthcare provider about when you’ll need to come in so they can make these changes for you.
• Go to an ER if your feeding tube slips out of place. With new tubes in your abdomen, it takes time for the tract between your stomach or small intestine and the outside of your body to mature. This typically takes six to eight weeks. It’s a medical emergency if the tube falls out or is pulled out before that time. Seek medical attention right away.

What are the risks of tube feeding?

After surgery to insert a tube, your belly may feel sore for a few days. You may notice drainage for a day or two. This is normal. It’s also common to experience certain side effects at first, like diarrhea, as your body adjusts to receiving nutrition in new ways.

Your provider can prescribe medications that can help with the pain. They can adjust your formula or feeding frequency to go easy on your digestive system as it adjusts.

Other issues can happen, but the risk of complications is small. Complications include:

• Sores in your nasal passageway (nasal tubes only).
• Clogged, damaged or displaced tube.
• Infection or leakage of stomach contents at the tube insertion site.
• Persistent gastrointestinal problems, including constipation, nausea and diarrhea.
• Aspiration pneumonia.

How long does a person keep a feeding tube?

How long you’ll need a feeding tube varies from person to person. Depending on the reason for the tube, you may use a feeding tube for a few weeks, several months or years. You may need a feeding tube long-term form to receive nutrition, medication or hydration (water).

When should I call my healthcare provider?

It’s important to care for your feeding tube as your provider instructs and keep your insertion site clean. If you have pain, redness, swelling or excessive leaking or itching, call your provider immediately.

If your tube is clogged, you can try gently flushing it with warm water. If that doesn’t work, call your provider.

Never attempt to loosen a clog by inserting wires into the tube.

If the tube comes out, get to an ER right away.