Understanding Feeding Tubes | The Feeding Tube Foundation

OVERVIEW

What is a feeding tube?

A feeding tube is a medical device designed to deliver nutrition to people who are unable to receive it orally. There are many different types of feeding tubes, as well as reasons that someone may require a feeding tube. Common causes of feeding tube dependency are conditions that affect a person's ability to safely swallow, such as dysphagia or throat cancer. The state of being fed by a feeding tube is also called "enteral feeding" or "enteral nutrition".

Administering Enteral Nutrition

There are many different ways to administer enteral nutrition. The method that you use to administer enteral nutrition will depend on the type of enteral access device placed, which will be decided by your healthcare provider and/or nutrition team. Some enteral access devices (feeding tubes) are placed surgically through a stoma.

Who can receive enteral nutrition?

The population of individuals who receive enteral nutrition ranges from neonates to senior adults. Each year, thousands of patients receive nutrition through a feeding tube in acute care settings, and many continue at home or in long-term care facilities.

What are the indicators of enteral nutrition?

There are over 350 conditions that may indicate the need of enteral nutrition support. The most common indicators of enteral nutrition support are patients who are unable to obtain nutrition orally as a result of a critical illness, gastrointestinal (GI) or non-GI disease, or cancer.

What are the benefits of enteral nutrition?

Enteral nutrition provides the nutrients required when a person cannot consume enough food or nutrients needed to maintain health, or recover from an illness, disease or condition. Without adequate nutrients, the risk of malnutrition increases, which can lead to adverse conditions or in severe cases, death. Enteral nutrition helps to maintain normal digestion and absorption of nutrients through the GI tract, which are necessary for proper body function and overall health. Enteral nutrition can help treat malnutrition and support the immune system, thus reducing the risk of infections.

What are the side effects of enteral nutrition?

Enteral nutrition is typically very well tolerated; however, some individuals experience side effects associated with enteral feeding. This includes GI-related side effects such as nausea, vomiting, diarrhea, constipation, and abdominal distention, as well as metabolic issues such as fluid and electrolyte imbalances, and glucose intolerance. Many of these side effects can be prevented or managed with appropriate monitoring.

How long can someone receive enteral nutrition?

Enteral nutrition may only be necessary in short-term periods, such as a few days or weeks, however, patients can also live a long and well life on enteral nutrition. The duration will vary from patient to patient and will depend vastly on the patient's clinical conditions.

What To Expect

Knowing what to expect after a feeding tube placement can help you get back to your everyday life as soon as possible.

How will I feel after the feeding tube placement?

You may have pain at your incision site or some discomfort in your nose and throat after insertion of your feeding tube. This should be temporary. You may receive pain medication to control your pain. You might also feel a little drowsy from the sedative and pain medications you received.

Tell a member of your care team if your pain is not well controlled by your medication because it can be a sign of a complication.

When can I go home?

You will stay in the recovery room, radiology department, or doctor’s office for a short period of time after your feeding tube placement. You will be discharged home when you are fully alert, breathing effectively, and your vital signs are stable. This generally takes less than an hour, depending on the type of sedation you receive.

You may still be a bit drowsy and will need a ride home from your procedure. You will not be able to drive for about 24 hours, and someone should stay with you during that time. Children, and some adults, may need to stay in the hospital overnight after a feeding tube placement.

When should I call my doctor?

It’s important to keep your follow-up appointments after a feeding tube placement. Contact your doctor if you have any concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

Bleeding or drainage from the tube site
Blocked or clogged tube
Dislodged tube
Fever
Inability to pass gas or have a bowel movement
Pain that is not controlled by your pain medication
Persistent nausea or vomiting
Pink or red tissue growing out from the tube site
Severe abdominal pain
Skin irritation around the tube site
Warmth, redness, pain, swelling or pus at the tube site

Risk Factors

After the procedure to insert a tube, the area of your body it was inserted into may feel sore for a few days. You may notice drainage for a day or two. This is normal. It’s also common to experience certain side effects at first, like diarrhea, as your body adjusts to receiving nutrition in new ways.

Your provider can prescribe medications that can help with the pain. They can adjust your formula or feeding frequency to go easy on your digestive system as it adjusts.

Other issues can happen, but the risk of complications is small. Complications include:

Sores in your nasal passageway (nasal tubes only).
Clogged, damaged or displaced tube.
Infection or leakage of stomach contents at the tube insertion site.
Persistent gastrointestinal problems, including constipation, nausea and diarrhea.
Aspiration pneumonia.

Lifestyle

You and your loved one’s medical care starts with you. Managing your care is more than managing a feeding tube routine. Explore resources below that address independent living and quality of life.

Having a tube-fed loved one can sometimes feel like it consumes all of your time and routine. While there are some additional considerations when your loved one has a tube, in most cases, the entire family can continue to live a rich, full, and active life! Tube feeding on the go can take some practice, but there are great options and tricks to make it easier.

If you need to warm feeds, consider bringing an insulated water bottle with hot water along to set the formula or blend in. Measure the feed ahead of time, and then allow it to warm in the water bottle or a separate bowl. A small cooler is a great way to bring multiple feeds with you and keep them at a safe temperature. You can also use a pump backpack for feeds on the go or hang the pump with a carabiner on a stroller, wheelchair, back of a car seat headrest, etc., or try out the Free Arm for a great on-the-go option to tube feed anywhere!

The biggest things to keep in mind when being out and about with your tube-fed loved one are:

keep the formula/blend appropriately hot/cold
bring sufficient formula/blend to cover any feeds while you’re out
make sure your pump is charged and bring a back-up option like a syringe
bring a back up kit! One of the scariest parts about being away from home is the potential for a tube to come out! Be prepared with a back-up tube and kit to ensure you can replace the tube no matter where you are

Diet & Exercise

While in some cases individuals with feeding tubes have digestive issues, the vast majority have a functioning digestive system! The only difference is their digestion is starting in the stomach or small intestine, while for oral individuals, digestion starts in the mouth. Some individuals may require specific formulas due to a medical condition or limitation, but for most, standard enteral formulas or blended diets are both adequate. And if your loved one doesn’t have an actual oral restriction where they are not allowed to have anything by mouth, have them join the rest of the family in meals as much as possible, even offering some of the meal if they’d like to participate in any way, do so! Eating is so much more than nutrition - it’s social, emotional, cultural, and more. Allow your loved one to be a part of that experience, even if it’s just being at the table with everyone while the tube feed runs or taking a lick of a piece of the meal.

Yes, there are cases where this isn’t true, but not every individual with a short bowel is tube-fed, nor is every person with metabolic disorders, heart conditions, kidney disease, liver disease, etc. This is not an argument against tube-feeding, but often medical professionals tend to forget that eating is more than just calories, vitamins, and minerals. You may find a formula that works best for your family, but in most cases, you can also share family foods with your tube-fed family member, as well, through blended feeds. There are also commercial blended options available if you want to provide a tube-feed option that more closely mimics an oral diet.

Much like nutrition, needs don’t typically change just because an individual is tube-fed, the same is true for exercise and movement. While other medical considerations or concerns may impact your loved one’s physical abilities, the tube itself isn’t usually a big limitation. Walks, hikes, bike rides, and the like are all great options. Contact sports are sometimes discouraged, as the risk of the tube being bumped or dislodged is generally higher. However, this is a conversation worth having with your provider, and know there are also great options out there like g-tube belts, that may make some of these activities less risky. Even swimming is an option! Just keep in mind that NG/J tubes need to be closed and clamped, while G and J tubes should typically be covered with protective tape so water doesn’t get it. The stoma also needs to be fully healed, which means no submerging the site for about 2 months. Finally, while oceans, saltwater ponds, and chlorinated pools are all considered safe, avoid lakes and streams due to concerns about pathogens and bacteria.

Water Safety

Water safety is one of the most commonly expressed concerns before and after getting a feeding tube. We're here to help guide you through the fears and concerns regarding aquatic safety with a feeding tube.

Important To Know

Every patient, every story, and every feeding tube is uniquely cared for. When it comes to water safety, your health care provider will be a great resource to answer questions you may have regarding your specific medical condition. Generally speaking, after having a feeding tube placed, such as a MIC-KEY gastrostomy tube, it is best to wait at least 48 hours before submerging into bath or shower water with your feeding tube to ensure the stoma has healed.

Pools

It is recommended to wait at least 6 weeks post procedure before submerging into a swimming pool with a feeding tube. Patients often wonder if their feeding tube should be covered when entering into a swimming pool. There is no requirement to cover your feeding tube while swimming, as the stoma site should be fully healed after 6 weeks, however, if you prefer to cover the site during swimming, we recommend using a waterproof dressing such as AquaGuard or Tegaderm.

Lakes, Ponds, Beaches

While oceans are typically fine for tube-users, these bodies of water are still at risk for pollution. Ideally, you should be able to obtain this information from the local beach health monitoring official. Ask which beaches are monitored, how often they are checked and what they are tested for. When the results are provided, don’t be afraid to ask for help in understanding them. If your beach is not monitored, avoid swimming after heavy rain and near storm drains. Be aware of trash and other pollution in the water. You can also refer to the CDC’s Health Swimming webpage for ocean reports.

Palliative Care

Palliative care aims to enhance the quality of life for individuals coping with serious illnesses such as cancer. It can be provided at any stage, from diagnosis through treatment and beyond. This information is designed to help you understand more about palliative care.

Understanding Palliative Care

Palliative care is a specialized form of medical care for individuals with serious illnesses, including conditions that result in feeding tube dependency. It aims to enhance quality of life by assisting patients and their caregivers in managing symptoms and treatment side effects. This approach is integrated with the healthcare team's efforts to enable individuals with serious illnesses to live as fully as possible for as long as possible.

Palliative care is suitable for individuals of any age and at any point in a serious illness. It should be implemented whenever there are symptoms that require management.

What's the difference between palliative care and hospice care?

How they are alike

The goal of both palliative care and hospice care is to provide better quality of life and relief from symptoms and side effects for people with a serious illness.
Both have special care teams for a person's physical, emotional, mental, social, and spiritual needs.
Hospice care often includes palliative care.

How they are different

When care is given:

Palliative care can be offered and provided at any stage of a serious illness.
Hospice care is offered and provided for patients during their last phase of an incurable illness or near the end of life.

Who Should Get Palliative Care and Why?

Any person diagnosed with a serious illness who is having symptoms should get palliative care. People with complex medical problems, for instance, someone who is diagnosed with and being treated for heart failure, kidney disease, diabetes, or cancer, should get palliative care. These serious illnesses often lead to physical, emotional, spiritual, and social problems that go beyond what the medical team can provide.

Finding a Palliative Care Program

Typically, your doctor or care team can provide and initiate palliative care services. However, if palliative care isn't offered or accessible, or if there's another reason it's not available, they can refer you to a specialized provider or team dedicated to palliative care.

For resources on palliative care providers, consider the following organizations: