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The Whys and Why-Nots of Feeding Tube Placement

Information You Can Use To Decide For ,or Against, Feeding Tube Placement

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Updated July 07, 2008

The Whys and Why-Nots of Feeding Tube Placement

PEG tube

Photo © A.D.A.M.

What is a feeding tube?

A feeding tube is a device used to deliver nutrition directly into the stomach of a person who can't swallow food on his or her own.

When are feeding tubes necessary?

Some common reasons why people might need a feeding tube are:
  • Due to an ineffective swallowing mechanism
  • Due to being in a coma or in a vegetative state
  • Due to head and neck cancers which prevent swallowing
  • Due to a chronic loss of appetite in the setting of severe illness or brain injury

What kinds of feeding tubes are there?

The three main kinds of feeding tubes are:
  • Nasogastric: Also known as a NG tube, this feeding tube is less invasive than G or J tubes (see below) and is only used temporarily. Nasogastric tubes are thin, and can be easily passed down from the nose, through the esophagus, and into the stomach, and can be pulled out just as easily. Because these tubes are thin, they often become clogged, requiring the insertion of a new one. Also, their chronic use has been associated with sinusitis and other infections. In spite of this, they are the easiest and most reliable way to feed patients who have swallowing difficulties in the hospital.
  • Gastric tubes: Also known as G tube or PEG tube, the gastric tube is a permanent (but reversible) type of feeding tube. G tube placement requires a small surgery in which the G tube is advanced from the abdominal skin directly into the stomach. The tube is kept inside the stomach by a coiled wire, commonly called a “pigtail,” or by a small air-inflated balloon. The surgery is safe but in a small percent of cases it can lead to complications, such as bleeding and infection.
  • Jejunostomy tubes: Also known as a J tube or PEJ tube, a jejunostomy tube is similar to a G-tube, but its tip lies inside the small intestine, thus bypassing the stomach. It is mainly reserved for people whose stomach has an impaired ability to move food down into the rest of the intestine due to poor motility. It is also commonly used in people who suffer from severe gastro-esophageal reflux disease (GERD), and in those who are excessively obese.

When is the use of a feeding tube clearly beneficial?

Feeding tubes are especially helpful for people who are unable to feed themselves as a result of an acute illness, or surgery, but who otherwise have a reasonable chance to recover. They are also helpful in patients who are unable to swallow temporarily, or permanently, but who otherwise have normal or near-normal function. In such instances, feeding tubes might serve as the only way to provide much needed nutrients, and/or medications.

Are feeding tubes helpful in stroke?

Yes, they are. Studies have shown that up to 50% of all patients admitted to the hospital with a stroke are significantly malnourished by the time they are discharged. More importantly, complementary studies suggest that preventing malnutrition by feeding patients through a feeding tube in the early phase of an acute stroke improves their recovery by comparison with patients who do not receive early feeding. The preferred type of feeding tube used within the first 30 days after a stroke is the NG tube.

Controversial uses for G and J feeding tubes

In some instances, a feeding tube is controversial. They include:
  • Placing a permanent feeding tube in a person who is comatose due to a progressive and fatal disease (such as metastatic cancer) that will soon end his/her life.
  • Placing a permanent feeding tube in a person who is unable to express his wishes due to his disease, but who had previously stated to his loved ones that he would never want to be fed through a feeding tube.
  • Placing a permanent feeding tube in a comatose patient who has extensive and irreversible brain damage and no meaningful chance to recover, but who could be kept alive indefinitely with artificial feedings.
  • Placing a feeding tube in a person who has signed a living will which specifies that he/she would never want to be fed through a feeding tube.

Unfortunately, thorough discussions between physicians and families about these issues do not take place as often as they should. Many doctors rush to place a feeding tube, and many families rush into agreeing to it without having a full understanding of the benefits and consequences of permanent feeding tube placement.

Questions to ask your doctor:

Important questions to ask doctors about feeding tube placement in a loved one include:
  • Does placing a feeding tube improve the chance that my loved one will recover?
  • What are the risks and benefits of G/J-tube placement?
  • How should the surgery site look like after surgery?
  • Does the G/J tube require maintenance?
  • Should feeding through the tube be given continuously or intermittently?
  • If I were to have any problems with the feeding tube, who should I call?

Sources:

William M. Plonk, Jr., Practical Gastroenterology, June 2005.

Dennis M, Lewis S, Cranswick G, Forbes J; FOOD Trial Collaboration FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke. (2006) Health Technol Assess. Jan;10(2):iii-iv, ix-x, 1-120.

Hillel M. Finestone, MD, Linda S. Greene-Finestone, MSc, RD, Elizabeth S. Wilson, BSc, Robert W. Teasell, MD; Malnutrition in Stroke Patients on the Rehabilitation Service and at Follow-Up: Prevalence and Predictors; Arch Phys Med Rehabil Vol 76, April 1995 page 310.

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