Facts about tube-feeding

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What is tube feeding? 

Tube feeding is a way to provide nutrition to people who can not or will not eat and/or drink enough to keep their body healthy. Tube feeding is sometimes used on a short-term basis until a patient’s condition improves. Other times, it is a permanent method of feeding and is impossible to stop without resulting in malnutrition, dehydration, and the eventual death of a patient.
Tube feeding usually is given directly into the stomach or intestines (enteral tube feeding) or in some cases via a central vein, called parenteral tube feeding. Tube feeding is important to improve or maintain the health of some patients. Whether or not a patient is a candidate for tube feeding is a personal decision that involves the patient, family, and medical team.
How does tube feeding work?
A tube is placed into the stomach to deliver liquid food. The tube is placed through the nose and down the esophagus (nasogastric [NG] tube) or directly into the stomach (often called a percutaneous endoscopic gastrostomy [PEG] tube) or intestine (usually called a jejunostomy tube [J-tube]). The PEG and J-tube placements require minor surgery. PEG tubes are the most common method of tube feeding.
Once a tube is placed, a special liquid formula is run through the tube and into the body. The tube-feeding formula contains a complete blend of nutrients. Extra liquid and medications are given through the tube. If the tube is attached to a pump, it runs continuously. If the feeding is given in a larger amount several times per day, it is known as a bolus feeding.
Is tube feeding recommended for every patient?
It is necessary to make a careful decision when deciding whether or not to use a feeding tube for the elderly or a chronically ill patient. Not every person who cannot or will not eat is a good candidate for tube feeding.
Some studies have shown that for patients with end-stage dementia, a tube feeding will not extend life, increase weight, or reduce the incidence of pressure ulcers or aspiration (choking on food or fluid), or minimize suffering. Tube feeding will not cure a chronic disease or improve a person’s dementia. The placement of a feeding tube involves legal and ethical issues for patients with dementia. If possible, it is ideal to obtain the patient’s feelings regarding tube feeding in writing while the patient still is capable of making that decision. If a patient cannot make the decision, the responsible party and medical team should discuss what is in the patient’s best interests.
How can I make sure that my loved one is getting adequate nutrition?
Tube feeding is ordered by a doctor and reviewed by a registered dietitian and others to make sure that the correct amount of nutrition (protein, calories, fluid, vitamins, and minerals) is provided. If needed, a special tube-feeding formula for diabetes, kidney disease, or lung disease is ordered. The patient’s weight, laboratory values, and bowel habits are monitored closely for tolerance to the tube feeding and adequate nutrition.
Why is a tube-feeding order sometimes changed?
Based on monitoring, a doctor or dietitian may suggest changing the tube-feeding formula or amount of feeding or fluid provided. This may help to better meet a patient’s nutritional needs, or to address symptoms such as nausea, vomiting, diarrhea, or other tolerance problems related to the original feeding. In most cases, changing the feeding is nothing to concern yourself about. It is just an attempt to better meet a patient’s nutritional needs.
Can a person receiving tube feeding eat regular food again?
Maybe! Some patients receiving tube feeding need the feeding temporarily to help with recovery from surgery or malnutrition. Others have permanent swallowing and/or eating problems, and do not have the ability to eat food again.
Make sure to discuss the potential for return to oral feeding with the medical team. Before the tube is placed, everyone should clearly understand whether or not the patient is expected to return to oral feeding and the plan of care for the patient. 
Why would someone eat and still receive a tube feeding?
Some patients simply are unable to eat enough to maintain their weight and health status. In those cases, tube feeding sometimes is ordered for supplemental feeding. Individuals who can eat but also receive a tube feeding usually are monitored to make sure the correct texture of food is provided and the correct amount of supplemental feeding is available to keep the patient healthy.
 
References and recommended readings
Chernoff R. Tube feeding patients with dementia. Nutr Clin Pract. 2006;21:142-146.
Mahan KL, Escott-Stump S. Krause’s Food and Nutrition Therapy . 12th ed. St Louis, MO: Saunders/Elsevier; 2008.

Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database Syst Rev . 2009;April 15:CD007209.
 

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