"Gavage" redirects here. For the practice in the Mauritania, see Leblouh.
|
|
This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (August 2012) |
| Feeding tube |
| Intervention |
A malnourished child with a feeding tube. |
| ICD-9-CM |
96.35 |
| MeSH |
D004750 |
A feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. The state of being fed by a feeding tube is called gavage, enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. A variety of feeding tubes are used in medical practice. They are usually made of polyurethane or silicone. The diameter of a feeding tube is measured in French units (each French unit equals 0.33 millimeters). They are classified by site of insertion and intended use.
|
Contents
- 1 Conditions requiring tube feeding
- 2 Types of feeding tubes
- 2.1 Nasogastric
- 2.2 Nasojejunal and Nasoduodenal
- 2.3 Gastrostomy or Gastric feeding tube
- 2.3.1 Gastric drainage tube
- 2.4 Gastrojejunostomy feeding tube
- 2.5 Jejunostomy feeding tube
- 3 Effectiveness
- 3.1 Children
- 3.2 Advanced dementia and adult failure to thrive
- 3.3 Eating disorders
- 3.4 ICU
- 3.5 Neurologic disease and mechanical obstruction
- 4 Complications of feeding tubes
- 5 K-E diet
- 6 See also
- 7 References
- 8 External links
|
Conditions requiring tube feeding
There are hundreds of conditions that can require tube feeding. Some of the most common conditions requiring tube feeding include prematurity, failure to thrive or malnutrition, neurologic or neuromuscular disorders, inability to swallow, anatomical or post-surgical malformations of the mouth or esophagus, eosinophilic disorders, cancer, and digestive disorders.
Types of feeding tubes
The most common types of tubes include those placed through the nose, including Nasogastric, Nasoduodenal, and Nasojejunal tubes, and those placed directly into the abdomen, such as a Gastrostomy, Gastrojejunostomy, or Jejunostomy feeding tube.[1]
Nasogastric
A nasogastric feeding tube or NG-tube is passed through the nares (nostril), down the esophagus and into the stomach. This type of feeding tube is generally used for short term feeding, usually less than a month, though some infants and children may use an NG-tube longterm. Individuals who need tube feeding for a longer period of time are typically transitioned to a more permanent gastric feeding tube. The primary advantage of the NG-tube is that it is temporary and relatively non-invasive to place, meaning it can be removed or replaced at any time without surgery. NG-tubes can have complications, particularly related to accidental removal of the tube and nasal irritation.
Nasojejunal and Nasoduodenal
A Nasojejunal or NJ-tube is similar to an NG-tube except that it is threaded through the stomach and into the jejunum, the middle section of the small intestine. In some cases, a nasoduodenal or ND-tube may be placed into the duodenum, the first part of the small intestine. These types of tubes are used for individuals who are unable to tolerate feeding into the stomach, due to dysfunction of the stomach, impaired gastric motility, severe reflux or vomiting. These types of tubes must be placed in a hospital setting.
Gastrostomy or Gastric feeding tube
A gastric feeding tube (G-tube or "button") is a tube inserted through a small incision in the abdomen into the stomach and is used for long-term enteral nutrition. One type is the percutaneous endoscopic gastrostomy (PEG) tube which is placed endoscopically. The position of the endoscope can be visualized on the outside of the patient's abdomen because it contains a powerful light source. A needle is inserted through the abdomen, visualized within the stomach by the endoscope, and a suture passed through the needle is grasped by the endoscope and pulled up through the esophagus. The suture is then tied to the end of the PEG tube that will be external, and pulled back down through the esophagus, stomach, and out through the abdominal wall. The insertion takes about 20 minutes. The tube is kept within the stomach either by a balloon on its tip (which can be deflated) or by a retention dome which is wider than the tract of the tube. G-tubes may also be placed surgically, using either an open or laparoscopic technique.
Some individuals continue to use a long, catheter-like tube, while others use a small "button" with a detachable extension set for feedings. Most G-tubes can be changed easily at home. Gastric feeding tubes are suitable for long-term use, though they sometimes need to be replaced if used long term. The G-tube can be useful where there is difficulty with swallowing because of neurologic or anatomic disorders (stroke, esophageal atresia, tracheoesophageal fistula), and to avoid the risk of aspiration pneumonia. However, in patients with advanced dementia or adult failure to thrive it does not decrease the risk of pneumonia.
Gastric drainage tube
A G-tube may instead be used for gastric drainage as a longer term solution to the condition where blockage in the upper reaches of the small intestine causes bile and acid to accumulate in the stomach, typically leading to periodic vomiting. Where such conditions are only short term, as in a hospital setting, a nasal tube connected to suction is usually used. A blockage lower in the intestinal tract may be addressed with a surgical procedure known as a colostomy, and either type of blockage may be corrected with a bowel resection under appropriate circumstances. If such correction is not possible or practical, nutrition may be supplied by parenteral nutrition.
Gastrojejunostomy feeding tube
A gastrojejunostomy or GJ feeding tube is a combination device that includes access to both the stomach and the jejunum, or middle part of the small intestine. Typical tubes are placed in a G-tube site or stoma, with a narrower long tube continuing through the stomach and into the small intestine. The GJ-tube is used widely in individuals with severe gastric motility, high risk of aspiration, or an inability to feed into the stomach. It allows the stomach to be continually vented or drained while simultaneously feeding into the small intestine. GJ-tubes are typically placed by an Interventional Radiologist in a hospital setting. The primary complication of GJ-tubes is migration of the long portion of the tube out of the intestine and back into the stomach.
Jejunostomy feeding tube
A jejunostomy feeding tube (J-tube) is a tube surgically inserted through the abdomen and into the jejunum (the second part of the small intestine). The procedure is called a jejunostomy. There are several techniques for placement, including a direct surgical or endoscopic technique, or a more complicated Roux-en-Y procedure. The J-tube may use a long, catheter-like tube or a button. Depending on the placement type, the tube may be changed at home, or may need to be changed at a hospital. A J-tube is helpful for individuals with poor gastric motility, chronic vomiting, or at high risk for aspiration.
Effectiveness
The effectiveness of feeding tubes varies greatly depending on what condition they are used to treat.
Children
Feeding tubes are used widely in children with excellent success for a wide variety of conditions. Some children use them temporarily until they are able to eat on their own, while other children require them longterm. Some children only use feeding tubes to supplement their oral diet, while others rely on them exclusively.
Advanced dementia and adult failure to thrive
There is strong evidence that feeding tubes do not help patients with advanced dementia or adult failure to thrive, and expert opinion[2][3][4][5] recommends they not be offered to these patients. Studies have definitively proven that they do not prolong life, they do not decrease the risk of pneumonia, they do not improve wound healing, they do not help weight gain, and they do not help the patient regain any strength or functional ability such as walking or self-care. Patients with advanced dementia also often pull at their G tubes causing them to be dislodged, and frequently require physical restraints, such as tying their wrists to the bed, to keep this from happening.[6]
Eating disorders
Patients with the eating disorder anorexia nervosa may be tube fed if they are significantly malnourished. This can be voluntary or in some cases where the patient is resistant to feeding under the force of the Mental Health Act. Patients may tamper with their feeds, which can interfere with the effectiveness of feeding.
ICU
Nasogastric tubes are often used in the intensive care unit (ICU) to provide nutrition to critically ill patients while their medical conditions are addressed. There is moderate evidence for use of feeding tubes in the ICU, especially if requiring mechanical ventilation for more than three days.
Neurologic disease and mechanical obstruction
There is at least moderate evidence for feeding tubes improving outcomes for chronic malnutrition in patients with cancers of the head and neck, acute stroke while the patient undergoes rehab, and ALS.
Complications of feeding tubes
Gastric feeding tubes have a variety of complications. As gastric feeding tubes are placed as part of a procedure that punches a hole in the stomach and skin, this can lead to leaking of contents into the abdomen causing severe infection and death. The most frequent complication is irritation around the site of the insertion, generally caused by stomach acid and feedings leaking around the site. Barrier creams, dressings, and frequent cleaning is generally recommended.[citation needed]
Nasogastric feeding tubes, if inserted incorrectly, can cause collapsed lungs and consequently, death; however this is an extremely rare complication.[7]
K-E diet
The K-E diet (short for Ketogenic Enteral diet) involves being tube-fed a carbohydrate free mixture of protein and fats, adding up to 800 calories a day. The 10-day treatment was created by the Florida based Dr. Oliver Di Pietro for people who want to lose weight. It received a great deal of publicity because of an article in the New York Times about a bride who did the K-E diet to fit into a dress for her wedding.[8][9] It has also attracted criticism from experts who have described the diet as "stupid" and "outrageous".[10]
See also
- Bioethics
- Force-feeding for tube feeding against an individual's will or as torture
- Nutrient enema
- Nasogastric tube
- Gastrostomy
- Percutaneous endoscopic gastrostomy
- Jejunostomy
References
- ^ Peggi Guenter and Marcia Silkroski, Tube Feeding: Pract Guidelines & Nursing Protocols, Aspen Publishers, 2001, pp. 51-68; Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. NICE Clinical Guidelines, No. 32. National Collaborating Centre for Acute Care (UK). London: National Collaborating Centre for Acute Care (UK); 2006 Feb., chapter 9.
- ^ http://jama.ama-assn.org/content/282/14/1365.short
- ^ http://archinte.ama-assn.org/cgi/content/abstract/157/3/327
- ^ http://archinte.ama-assn.org/cgi/content/abstract/161/4/594
- ^ http://www.drplace.com/Feeding_Tubes_in_Patients_with_Severe_Dementia.16.28273.htm
- ^ Peck, A.; Cohen, C. E.; Mulvihill, M. N. (1990). "Long-term enteral feeding of aged demented nursing home patients". Journal of the American Geriatrics Society 38 (11): 1195–1198. PMID 2123217. edit
- ^ "Stomach Tubes". http://www.thoracic.org. American Thoracic Society. http://www.thoracic.org/clinical/critical-care/patient-information/icu-devices-and-procedures/stomach-tubes.php. Retrieved Friday March 30, 2012.
- ^ Lee, Linda (13 April 2012). "Bridal Hunger Games - Losing Weight in Time for the Wedding". The New York Times. http://www.nytimes.com/2012/04/15/fashion/weddings/Losing-Weight-in-Time-for-the-Wedding.html?pagewanted=all. Retrieved 25 September 2012.
- ^ "Feeding tube diet: does it work and is it safe?". http://www.timeslive.co.za/lifestyle/2012/04/19/feeding-tube-diet-does-it-work-and-is-it-safe.
- ^ "Feeding tube diet raises eyebrows". CNN. 19 April 2012. http://thechart.blogs.cnn.com/2012/04/19/feeding-tube-diet-raises-eyebrows/.
External links
- American Society for Parenteral and Enteral Nutrition
