Tube feedings

Nutrients, either a special liquid formula or pureed food, are delivered to apatient through a tube directly into the gastrointestinal tract, usually into the stomach or small intestine. Tube feeding provides nutrition to patientswho are unable or unwilling to eat food. Conditions where tube feeding is considered include protein-energy malnutrition, liver or kidney failure, coma,or in patients who cannot chew or swallow (dysphagia) due to stroke, brain tumor, or head injury. Patients who are receiving radiation therapy or chemotherapy treatments for cancer may also be candidates for tube feedings.

A flexible, narrow tube is inserted into some portion of the digestive tractand liquid formulas or liquefied foods are placed into the tube to meet the patient's nutritional needs. The feeding may be pumped into the tube or allowed to drip into the tube continuously or at scheduled feeding times.

A feeding tube can be inserted by a surgical or nonsurgical procedure in several positions along the gastrointestinal tract. The tube may be inserted intothe nose and passed down the throat and through the esophagus. A nasogastrictube is inserted through the nose with the end of the tube reaching into thestomach. A nasoduodenal or nasojejunal tube is inserted through the nose andends in either the duodenum or jejunum, both of which are portions of the small intestine. This type of tube placement is usually used for short term feeding. Surgical placement of a feeding tube may be done if there will be a long term need for feeding that bypasses the upper digestive tract. An esophagostomy creates an opening in the esophagus, a gastrostomy creates an opening into the stomach, and a jejunostomy creates an opening into the jejunum. The feeding tube is then inserted through the surgically-created opening.

Tube feedings can be a mixture of regular foods which are blended with liquidto make a consistency which will pass through the tube. Nutritionally balanced liquid products are often more convenient to use and ensure a balance of proteins, fats, and carbohydrates along with vitamins and minerals. Specialized formulas are also available to meet almost any nutritional need. For example, patients with severe burns, protein-energy malnutrition, or slow wound healing may require formulas that are higher in protein. Patients with renal failure may require low protein formulas with lower concentrations of minerals and vitamins.

Patients with ostomy feeding tubes may have the tube positioned level with the surrounding skin. A cap or button can be placed over the opening so that itcan be more comfortably concealed under clothing. The opening and surrounding tissue need to be cleaned and inspected regularly to prevent infection. Forpatients with a tube inserted through the nose, daily nasal hygiene is important and the mouth and lips should be kept moist. Good mouth care is necessary for any patient with a feeding tube.

Formula from the tube can back-up in the esophagus and be breathed into the trachea and lungs causing aspiration pneumonia. The placement of the tube should be checked frequently and the head of the bed elevated during and after feeding to prevent the solution from moving back up the digestive tract. Feeding tubes can also become clogged and need to be flushed regularly with water.If the feeding formula is too concentrated or given too fast, the patient mayexperience nausea, vomiting, cramping, and bloating. The feeding may need tobe diluted with liquid or the rate at which it is given decreased. Diarrheaor constipation can occur if the feeding is not the right composition or doesnot provide enough liquid. The tube itself can irritate the nasal passage, esophagus, or surrounding tissues.

A patient may be able to transition back to a normal diet of solid foods after short term supplementation with formula through a feeding tube. In cases where long term nutritional therapy is required, all of the patient's nutritional needs will have to be provided by the formula. The balance of fluids, calories, proteins, fats, vitamins, and minerals may need to be adjusted periodically.

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