What is tube feeding/ enteral feed?
Our body needs nutrition to stay strong and live a healthy life. If a patient is unable to eat, difficult to swallow or need nutritional supplementation when the intake by mouth is inadequate, tube feeding is advised to meet the nutritional requirement.
Tube feed is liquid form of nourishment delivered to your body through a specially designed flexible tube.
The nutrients within the feed are similar to what is available from normal food and also digested in the same way. The tube feed covers calories, protein, fat, fibers and all micronutrients required for the patient on daily basis.
The process of feeding through a tube is called gavage or enteral feeding. Depending on the need of tube feeding, it may be kept for weeks or months. The tube feeding is then gradually weaned off and the tube removed once the disease condition improves and patient is able to swallow adequate liquid or semisolid food.
In some cases, tube feeding may be required for a very long period or for life. Having a feeding tube means learning new skills and adopting new routines.
Types of Tube Feeds:
Type of Tube
|Where it is inserted||
When it is used
|Nasogastric Tube||Through the nose down the oesophagus into the stomach||Short term – 6 to 8 weeks|
|Naso jejunal Tube||Through the nose, down the oesophagus, down the stomach to small jejunum, part of small Intestine||When feeding into the stomach is not tolerated.|
|Gastrostomy Tube (*PEG/**RIG)||Directly into the stomach through a small stoma (opening) created by a surgical incision over the abdomen||Long term use, more than 6 months|
|Jejunostomy Tube||Directly into the jejunum through a small opening (Stoma) created by surgical incision on the abdomen.||Post surgeries of the stomach where stomach need rest to heal.|
*PEG: Percutaneous Endoscopic Gastrostomy
**RIG: Radiologically Inserted Gastrostomy
Indications needing tube feed:
- Unconscious patient with no swallowing/Gag reflex.
- Post surgical procedures of Gastrointestinal system
- Inability to swallow due to disease conditions (tumor, swelling, injury, cancer)
- Surgery inside oral cavity (mouth).
- Severe trauma of head and neck
- Critical Illnesses with altered sensorium.
- Inability to tolerate oral feeds.
- Supplementation of Nutrition and fluid requirements.
SuVitas Tube Feed Programme
1. Care of patient on Tube feed
- Reassurance and explaining the need for tube feeds to relieve anxiety associated with tube feeding.
- Oral hygiene: Mouth and throat harbor infectious microorganisms which can trickle down causing respiratory infections. When a patient is not taking oral feeds, salivation decreases and the mouth become dry and coated. It harbors odor causing bacteria producing bad breath. So keeping the mouth clean and odor-free is very essential.
- Mouthcare: every 8 hourly. If the patient is conscious, make the patient gargle with diluted betadine mouthwash or plain lukewarm water.
- Brush teeth daily if patient is conscious. If unable to swallow or spit, mouth care will be given by skilled nurses every eight hours.
2. Care of the tube:
- Once the feeding tube is inserted and ensuring that the tube is in place, fix it with tape and secure properly. The tube fix is replaced when it is loose or dirty.
- Prevention of any traction (pull) on the tube as it may get dislodged or displaced. The tube at the tip of the nose is marked.
- The tube is cleaned by flushing with water after every feed and closing the clamp well.
- PVC Nasogastric (NG) tube is changed after 15 days. Poly urethane or silicone NG tube is kept for 4-6 weeks as they are unaffected by gastric acid.
- Surgically placed PEG or jejunostomy tube could be kept for longer period.
- Till the ostomy heals, daily dressing will be required. Once wound is healed and stoma is healthy, dressing is not required. A clean gauze piece can be kept around the tube to prevent spillage of feed and contaminating the stoma.
- The distal part (part which is away from body or the tail part) of the tube over abdomen is fixed to prevent traction. The tube is clamped well.
3. Feeding Procedure:
- Position: The head is kept elevated to minimum 30 degree before feeding.
- If the patient is on cuffed tracheostomy tube and the cuff is in deflated state, the cuff is inflated before feeding to prevent aspiration of fluid into lungs.
- Aspiration is checked and stomach content withdrawn into the syringe and pushed back before feed, ensuring the tube is in place.
- If no fluid is present on withdrawing, the position is adjusted and rechecked. The patient is not fed when in doubt as it can cause aspiration of fluid into the lungs if the tube is misplaced.
- Feed: Amount and content will be as advised by the dietician in diet chart.
- Temperature of the feed will be lukewarm, neither cold, not too hot.
- The piston is removed and poured gently with gravity. Forcing by piston using pressure can cause mucosal damage (lining of the stomach and intestine). In between feed, air will not be allowed to enter the tube. The tube is kept pinched.
- Once feed is over, flushed with 20-50 ml of plain water. The clap is closed to prevent back flow.
- The patient’s head is kept in elevated position for 30-60 min post feeding.
- The feeding syringe and all other re-usable articles are cleaned thoroughly immediately after use.