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Understanding Tube Feeding: Types of Feeding Tubes, How to Feed, and What to Feed

Tube Feeding

What Is Tube Feeding?

Nutrition is essential for growth and development in children, as well as for weight maintenance and meeting the needs of adults. However, not everyone can fulfil their nutritional requirements through oral intake. Some children may be born not yet ready to feed or may be unable to do so safely. Additionally, certain medical conditions can make it difficult for adults to meet their nutritional needs orally. In such cases, a feeding tube may be the most appropriate solution. Feeding tubes can be used for a variety of purposes, from supplementing oral intake to providing all necessary nutrition and fluids, as well as administering medications. While some individuals require feeding tubes only for a short period, others may need them for years or even for life.

What Types Of Feeding Tubes Are There?

Nasogastric Tube (NG Tube):

This is usually a temporary tube inserted through the nose and down to the stomach. It can be inserted at the bedside or at home.

Nasojejunal Tube (NJ Tube):

This is usually a temporary tube inserted through the nose that runs through the stomach and into the small intestine (jejunum). It needs to be inserted in radiology to ensure the correct placement.

Gastrostomy:

This is a more permanent tube inserted through a small hole in the abdominal wall directly into the stomach. It can be removed if it is no longer required and is less obvious, less uncomfortable, and requires less frequent changes. This requires a surgical procedure for the initial insertion. You may also see this called a G-tube, button, or PEG.

Jejunostomy:

This is a more permanent tube inserted through a small hole in the abdominal wall into the small bowel (jejunum). This requires a surgical procedure for the initial insertion and is also known as a J-tube, jejunostomy button, or JEJ.

Gastro-Jejunostomy Tube:

This is a more permanent tube inserted through a hole in the abdominal wall into the stomach. It has a longer tube inside that is then fed down into the small intestine (jejunum). This requires a surgical procedure for the initial insertion and is also called a G-J tube. It usually has two ports – one for a tube that sits in the stomach and one for a tube that sits in the jejunum.

How Do You Feed Through A Feeding Tube?

There are a few different ways to feed through a tube, and your dietitian will help you determine the best method for you or your child.

One way is to use a feeding pump to give continuous feeds at a controlled rate over a longer period of time, which is particularly useful for feeding into the jejunum. Feeds may be administered over 24 hours, overnight, or somewhere in between. A pump may also be used for intermittent feeding, where a feed is given over a few hours, several times a day, with breaks in between, similar to eating meals. A pump may be beneficial if there is poor tolerance of the feeds. However, pump feeding requires additional equipment to give feeds through the pump, which increases costs.

Another method is gravity feeds, in which a gravity drip bag or syringe (without the plunger) is used to give a larger volume of feed, known as a bolus, over a shorter period of time. Bolus feeds are usually given four to six times each day. The speed of the feed can be adjusted by changing the height of the bag or syringe. The higher the bag or syringe, the faster the feed flows through the tube. Gravity feeding requires less equipment to give the feed.

What Do You Feed Through A Feeding Tube?

Several factors must be considered when selecting what to feed through a tube. It depends on age, nutritional requirements, tolerance of feeds, type of tube, where the feed is fed into the body, and oral intake. Most people use a formula for feeds, which can either be a ready-made liquid or a powder. These formulas are designed to provide all the energy, protein, vitamins, and minerals required for survival. They may need some additional water to meet their fluid needs, and it is necessary to flush the feeding tube with water throughout the day to help prevent the tube from blocking. The tube should be flushed before and after a bolus feed, before and after medications, on starting and stopping feeds, or every 4-6 hours for continuous feeds.

Some people opt for blended or blenderised feeds. These are regular foods blended to a smooth liquid and given through the tube. They can only be given through tubes into the stomach, not the jejunum. They are also only suitable for bolus feeds and not continuous pump feeds. Blenderised feeds are harder work to prepare, and it can be difficult to get the balance of nutrients right. You must work with your dietitian to ensure all nutrient needs are met. Feeds must be smooth and liquid enough to flow through the tube, which may require larger volumes. Food hygiene and safety are also critical considerations. Some families prefer to feed blenderised feeds as they are “real” food and are believed to be better tolerated by some people.

Next Steps

Feeding tubes can provide necessary nutrition and fluids to individuals who cannot meet their needs orally, either due to medical conditions or being born not ready to feed. If you or a loved one is in need of nutrition support through tube feeding, it’s important to work with a healthcare professional and registered dietitian to determine the best type of feeding tube and feeding method for your specific needs. It’s also crucial to follow proper feeding and flushing protocols to ensure the safety and effectiveness of tube feeding.

If you need help with tube feeding, Naomi Crockett can help. She’s an extremely knowledgeable dietitian whose specialty is paediatric dietetics and tube feeding. Click to book or send an enquiry.

For more reading, check out www.chilfeeding.org