Enteral Feeding
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Enteral Feeding

(Tube Feeding)

Pronounced: EN-ter-al FEED-ing

En Español (Spanish Version)

Definition

Enteral feeding is the term used for the delivery of nutrients via a tube in patients who cannot receive food and nutrients normally because of a health condition.

Types of Enteral Feeding

  • Nasogastric or naso-enteral tubes are placed through the nose for short-term use.
  • Gastrostomy and jejunostomy tubes are surgically placed in individuals who require long-term feeding.

Gastrostomy Tube

exh38571_96472_1_Gastrostomy Tube.jpg

© 2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

  • Stomach
  • Small intestine

Reasons for Procedure

Infants and children who may require enteral feeding include those who have:

  • Gastrointestinal disorders, including those that inhibit nutrient absorption, digestion, secretion, and storage of nutrients
  • Damaged nervous systems or neuromuscular disorders including muscular dystrophy , spinal cord defects, or cerebral palsy
  • Cardiopulmonary disorders
  • Conditions of hypermetabolism, including burns or cancer

Adults who may require enteral feeding include those who:

  • Have conditions that inhibit swallowing such as stroke or surgery of the mouth or larynx
  • Are on a respirator for prolonged periods
  • Have conditions that inhibit proper digestion of nutrients such as surgical procedures in which portions of the gastrointestinal tract are removed

Risk Factors for Complications During the Procedure

Patients with gastroesophageal reflux may be at increased risk for vomiting or aspirating (swallowing food into the lungs) with enteral feeding.

Patients with bleeding or clotting disorders, or respiratory problems are at increased risk for surgical insertion of enteral feeding tubes.

What to Expect

Prior to Procedure

Patients should not take blood-thinning medications, including over-the-counter pain killers, for about a week before the enteral feeding tube is inserted. If you are allowed to leave the hospital the same day as the procedure, you will need someone to drive you home.

Patients should avoid food and water for at least eight hours prior to surgery.

Anesthesia

You will be given anesthesia as appropriate for your procedure. Insertion of a tube through the nose only requires mild sedation. Insertion of a tube through your abdominal wall into your stomach or intestine may require moderate sedation or even general anesthesia.

Description of the Procedure

The procedure varies according to the type of tube inserted. A nasally-inserted tube is placed through one of your nostrils and advanced into your stomach or small intestine by gently pushing the tube, allowing it to follow your normal intestinal pathway.

A gastrostomy is usually inserted using a gastroscope placed through your mouth. The lighted end of the gastroscope is visible through the abdominal wall. A small needle is then inserted through the abdominal wall into the stomach using the gastroscope as a guide. A long guidewire is then placed through the needle and grasped by the operator of the gastroscope. The wire is then pulled through the mouth, and a gastrostomy tube is threaded over the wire and advanced until it comes out through a small incision made in the abdominal wall. It is then secured in place by inflating a small balloon.

A jejunostomy tube is usually placed by making a small incision in your abdominal wall. Alternatively, laparoscopy may be used. The surgeon then grasps a section of your small intestine called the jejunum and makes a small opening. A tube is then placed through this opening and secured in place with sutures. It is then brought through your abdominal wall and secured once again with sutures.

After Procedure

Patients are carefully monitored to check for infection or bleeding following the insertion of the enteral feeding tube. Drainage around the tube is expected, and the dressing should be changed for several days following the procedure.

The incision site should be carefully washed each day with soap and water to prevent infection. Some soreness is normal.

How Long Will It Take?

Typically between 30-45 minutes

Will It Hurt?

Because of sedation and pain medication, the procedure typically causes little discomfort and only mild soreness.

Possible Complications

Possible complications of enteral feeding include:

  • Diarrhea
  • Breakdown of the skin surrounding the feeding tube
  • Leaking around the tube into your abdominal cavity
  • High blood sugars
  • Hyperphosphatemia (higher than normal phosphate levels in the blood)
  • Vomiting
  • Aspiration (inhaling foreign material into the lungs)—to decrease the risk of aspiration the head of the bed is raised between 30-40 degrees at the time of feeding and for an hour before and after feeding.
  • Feeding tubes may also become dislodged or clogged.

Average Hospital Stay

Typical hospital stay is 1-3 nights.

Postoperative Care

If an incision has been made, the wound should be healed in about 10 days. Until it has healed, patients should not swim or take baths (shower only). Patients should also avoid strenuous activity.

Outcome

An enteral feeding tube may be either temporary or permanent. Most patients who receive an enteral feeding tube do not have life-threatening complications from the tube. In fact, the tube should allow you to receive nutrients otherwise unavailable to your body, which should help your body heal the underlying illness.

Call Your Doctor If Any of the Following Occurs

You should call your doctor if the feeding tube becomes clogged, comes out, leaks, or if you experience choking or difficulty breathing.

If you have an infection or become dehydrated, see a doctor immediately. Symptoms include:

  • Redness of the skin surrounding the feeding tube
  • Fluids around the feeding tube changing in thickness and color
  • An odor from the fluid around the feeding tube
  • Pain, swelling, or warmth of the skin around the feeding tube
  • Fever
  • Dry skin lining the mouth, nose, or throat
  • Infrequent urination
  • Weight loss
  • Lack of tears

RESOURCES:

The Cleveland Clinic
http://www.clevelandclinic.org

State of Washington Office of Children With Special Healthcare Needs
http://depts.washington.edu

University of Pittsburgh Medical Center
http://www.upmc.com/home.htm

CANADIAN RESOURCES:

About Kids Health
http://www.aboutkidshealth.ca

Canada Source for Information about ALS
http://www.als.ca/manual-swallowing-tubefeeding.shtml

References:

Bentley D, Lifschitz C, Lawson M. Enteral and parenteral nutrition. In: Pediatric Gastroenterology and Clinical Nutrition. London, UK: ReMedica Publishing; 2001. Available at: http://www.naspghan.org/sub/ENTERAL_AND_PARENTERAL_NUTRITION.htm . Accessed February 27, 2007.

Role of endoscopy in enteral feeding. American Society For Gastrointestinal Endoscopy website. Available at: http://209.85.165.104/search?q=cache:AWd9CcrlZiUJ:www.asge.org/nspages/practice/patientcare/sop/upperGI/2002_enteral.pdf+enteral+feeding&hl=en&ct=clnk&cd=41&gl=us. Accessed February 27, 2007.



Last reviewed March 2008 by Ronald Nath, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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