What to Know When Deciding About Feeding Tubes

Feeding tube

A feeding tube is used to deliver nutrition directly into the stomach or the intestine for people who can't swallow food on their own.

When Are Feeding Tubes Needed?

Some common reasons why a person would need a feeding tube include:

  • Trouble swallowing due to weakness or paralysis from a brain injury or a stroke
  • Cancer involving the head or neck muscles, which interferes with swallowing
  • Being unable to purposefully control muscles due to a coma or a serious neurological condition
  • Chronic loss of appetite due to a severe illness such as cancer

When Are the Benefits of Feeding Tubes?

Feeding tubes are 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 for people who are temporarily or permanently unable to swallow 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.

Types of Feeding Tubes

There are three main kinds of feeding tubes, which include:

  • Nasogastric tube( NG tube)- This feeding tube is among the least invasive types of feeding tubes and is only used temporarily. NG tubes are thin, and are placed from the nose, through the esophagus, and into the stomach. The outer portion is generally kept in position with tape that is placed on the nose, and they can be easily pulled out without a surgical procedure. Overall, NG tubes are the easiest and most reliable way for people who have swallowing difficulties to receive adequate nutrition while in the hospital. NG tubes are thin, and they can become clogged, requiring replacement with a new tube every few days. Long term use of NG tubes has been associated with sinusitis and other infections.
  • Gastric tubes (G tube or PEG tube) -The gastric tube is a permanent (but reversible) type of feeding tube. G tube placement requires an interventional surgical procedure in which the G tube is advanced from the abdominal skin directly into the stomach. The tube is kept in place inside the stomach with a coiled wire or with a small air-inflated balloon. The surgery is considered relatively simple and safe, but as with any procedure, it can lead to complications, such as bleeding and infection.
  • Jejunostomy tube (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 intestine due to weakened motility.

Difficult Feeding Tube Decisions

In some instances, the decisions about a feeding tube are difficult or controversial. Examples of these situations include:

  • When a person is in a coma due to a progressive and fatal disease (such as metastatic cancer) that is expected to cause death very soon. Some family members may feel that a feeding tube can prolong life for only a few days, but may also lead to excessive pain and discomfort for the dying and unresponsive loved one. Find out more about understanding brain death here.
  • When a person is unable to express personal wishes due to the impact of the disease, but had previously stated to loved ones that he or she would not want to be fed through a feeding tube. This can be a difficult problem when some, but not all, family members are aware of their loved one's wishes, but the wishes are not written or documented anywhere.
  • When a person is in a coma, with extensive and irreversible brain damage and no meaningful chance to recover, but could be kept alive indefinitely with artificial feedings.
  • When a person has signed a living will which specifies that he/she would never want to be fed through a feeding tube, but the medical team and family have reason to believe that there is a chance of recovery if nutritional support is provided.

Questions to Consider When Making a Decision About Feeding Tube Placement

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?
  • Does the G/J tube require maintenance?
  • How should feeding through the tube be given?
  • If I were to have any problems with the feeding tube, who should I call?

A Word From Verywell

Nutrition is one of the most important factors in our health.

If you or your loved one has a serious illness that prevents eating by mouth, one of the types of feeding tubes can temporarily, or even permanently, provide calories and nutrients for the body to heal and thrive.

If a  person cannot eat and a feeding tube is not an option, then the fluids, calories and nutrients needed to survive are provided through intravenous (IV) method. Generally, getting calories and nutrients into the stomach or into the intestine is the best way for people to get the nutrients needed for the body to function optimally, and therefore a feeding tube provides better nutrition than that which can be provided through IV fluids.

If you or your loved one has a temporary or long term feeding tube, be sure to know which complications to look out for and which person on your health care team you should contact if you encounter a problem with the feeding tube while at home.

Further Reading:

Complex Feeding Decisions: Perceptions of Staff, Patients, and Their Families in the Inpatient Hospital Setting, Miles A, Watt T, Wong WY, McHutchison L Friary P, Gerontol Geriatr Med. 2016 Aug 22

 

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