• Enteral Feeding

    (Tube Feeding)

    Definition

    Enteral feeding, or tube feeding, is a way to deliver nutrients through a tube if you cannot take food or drink through your mouth. In some cases, you may only need tube feeding for a short period of time during your hospital stay. In other cases, you may need to go home with the tube in place and continue to receive nutrition this way. It may be temporary or permanent.
    Depending on your condition, you may have a tube that leads from the:
    • Nose to the stomach (nasogastric)
    • Abdominal wall to the stomach ( gastrostomy )
    • Abdominal wall to the intestines ( enterostomy )
    Gastrostomy Tube
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    Tube feeding provides you with proper nutrition when a condition makes it difficult, unsafe, or impossible to take food in through your mouth. Fluids and medicines can also be given through the tube.

    Possible Complications

    Possible complications of tube feeding include:
    • Diarrhea or constipation
    • Abdominal cramping or bloating
    • Breakdown of the skin surrounding the feeding tube
    • Irritated or infected stoma (the opening made in the abdomen)
    • High blood sugar (hyperglycemia)
    • Higher than normal phosphate levels in the blood
    • Nausea and vomiting
    • Inhaling the liquid formula into the lungs (aspiration)
    • Clogged or dislodged feeding tube
    If you have gastroesophageal reflux , you may be at increased risk for vomiting or aspirating.

    What to Expect

    Prior to Procedure

    If you are in the hospital or at a clinic, before the feeding, the staff will:
    • Thoroughly wash their hands before handling the supplies and the tube.
    • Set up the supplies. Depending on the feeding method, the supplies may include a syringe, measuring cup, feeding bag, electronic pump, and a pole to hang the bag.
    • Use a formula that will provide you with the right amount of protein, fat, carbohydrates, vitamins, minerals, and fluid.
    • Have you sit in an upright position.
    • Check to make sure that the tube is in the right position before putting the formula in it—For example, if you have a gastrostomy tube (g-tube), this may be done by using a syringe to extract a small amount of gastric fluids. Also, a ruler may be used to measure the length of the tube. If no gastric fluids are seen or if the length of the tube has changed, this may mean that the tube has become dislodged. You will then need further treatment.
    • Use a syringe to flush the tube with water to prepare you for the feeding.

    Description of the Procedure

    Tube feedings may be delivered by several methods. Depending on your condition, a nurse, trained caregiver, or family member may deliver the tube feeding. If you are able, you may receive training on how to give yourself the feedings.
    Syringe Method
    The feeding tube will be clamped or kinked. A large syringe will be attached to it. The formula will be poured slowly into the syringe. The tube will then be unclamped, and the syringe will be held high. This allows gravity to move the formula through the tube. When the feeding is done, the tube will be flushed with water to prevent clogging. The tube will then be clamped again, and the syringe will be removed. The tube will be re-capped and taped to the body. If the syringe method is used, you will need several feedings throughout the day. These are called bolus feedings.
    Gravity-Drip Method
    First, the formula will be poured into the feeding bag. The bag will be hung on a pole. The tube from the bag will be connected to the clamped feeding tube. Once the two tubes are connected, the feeding tube will be unclamped, allowing the formula to flow. As with the syringe method, gravity will move the formula through the tube. The flow can also be adjusted using a regulator clamp. When the feeding is done, a syringe filled with water will be used to flush the tube. Lastly, the tube will be capped and taped to your body. You will have several feedings during the day.
    Pump Method
    These steps are similar to the gravity-drip method. The difference is that the tubes are connected to an electronic pump. The pump will be programmed to deliver the formula at a set rate per hour. For example, with continuous feeding, you will slowly be fed throughout the day. If you need this approach, the feeding will be stopped every four hours. The tube will be flushed with water so that it does not get clogged. The pump method can also be used for bolus feedings.

    How Long Will It Take?

    • Syringe method: 15-20 minutes
    • Gravity-drip method: 1-2 hours
    • Pump method: varies depending on whether it is continuous feeding (eg, 8-12 hours) or bolus feeding

    Will It Hurt?

    Getting nutrition through a tube is not painful. You may have an upset stomach. To help prevent this:
    • Stay in an upright position during the feeding and for 30-60 minutes after the feeding.
    • If advised by your doctor, do not exercise after the feeding.

    Postoperative Care

    After the tube feeding, the following steps will be taken by you or a caregiver:
    • After thorough hand washing, the stoma site will be cleaned and gently dried.
    • Feeding tube supplies will be cleaned with warm water and dish washing soap. The supplies will be thoroughly rinsed and air-dried. For pumps, follow the manufacturer's guidelines.
    Remember that you still need to take care of your mouth and teeth. Brush your teeth twice a day, or as advised by your doctor.

    Call Your Doctor

    If you have tube feeding at home, you will be instructed to call your doctor right away if you have:
    • Clogged tube
    • Dislodged tube (most common during the first two weeks)
    • Choking or difficulty breathing during the feeding
    • Leaking of formula around the tube
    • Redness, swelling, pain, bleeding, or discharge at the stoma site
    • Cough, shortness of breath, chest pain
    • Signs of infection, including fever and chills
    • Nausea, vomiting, or abdominal swelling
    • Severe abdominal pain
    • Inability to pass gas or have a bowel movement
    • Diarrhea
    • Dehydration (eg, dry mouth, urinating infrequently, dark and/or bad smelling urine)

    RESOURCES

    Family Caregiver Alliance http://www.caregiver.org/caregiver/jsp/home.jsp/

    Family Doctor.org http://familydoctor.org/online/famdocen/home.html/

    CANADIAN RESOURCES

    Canadian Caregiver Coalition http://www.ccc-ccan.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    Abdominal and digestive home care: gastrostomy feeding by syringe. Cincinnati Children’s website Available at: http://www.cincinnatichildrens.org/health/info/abdomen/home/g-tube-syringe.htm . Updated June 2009. Accessed January 7, 2009.

    Enteral feeding: an overview. Dietetics website. Available at: http://www.dietetics.co.uk/article%5Fenteral%5Ffeeding.asp . Accessed January 7, 2009.

    Gravity drip tube feed instructions. University of Maryland Marlene and Steward Greenbaum Cancer Center website. Available at: http://www.umgcc.org/patient%5Finfo/pdf/tube%5Fbolus%5Fgravity.pdf . Accessed January 7, 2009.

    Home gastrostomy tube feeding. University of Michigan Health System Department of Surgery website. Available at: http://surgery.med.umich.edu/pediatric/clinical/physician%5Fcontent/procedures/gastronomy%5Ftube.shtml . Updated April 2007. Accessed January 7, 2009.

    Home nasogastric tube feeding. University of Pittsburgh Medical Center website. Available at: http://www.upmc.com/HealthAtoZ/patienteducation/Documents/NasogasTubeFeed.pdf . Accessed January 7, 2009.

    Kellicker P. Discharge instructions for enterostomy. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated October 2009. Accessed January 7, 2009.

    Smith N. How to care for your PEG tube. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated September 2009. Accessed January 7, 2009.

    Tube feeding. Oral Cancer Foundation website. Available at: http://oralcancerfoundation.org/dental/tube%5Ffeeding.htm . Accessed January 12, 2010.

    Tube feeding. UC Davis Cancer Center website. Available at: http://www.ucdmc.ucdavis.edu/cancer/pedresource/pedres%5Fdocs/tubefeeding.pdf . Updated February 2004. Accessed January 7, 2009.

    Tube feeding at home. Queensland Health Government website. Available at: http://www.health.qld.gov.au/nutrition/resources/etf%5Ftfah.pdf . Updated 2005. Accessed January 7, 2009.

    Tube feed tutorial. California State University website. Available at: http://www.csun.edu/~cjh78264/tubefeeding/tfadmin/index.html . Accessed January 7, 2009.

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