Courtesy of the Miller-Keane Medical Dictionary, 2000

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Tube Feeding

A means of providing total nutrition via a tube inserted into the gastrointestinal tract; it may be done to maintain nutritional status over a period of time or as a treatment for malnutrition. It can be used as the only source of nutrition or as a supplement to oral or parenteral feedings.

Patients who may require tube feeding include those unable to take in an adequate supply of nutrients by mouth because of the side effects of chemotherapy or radiation therapy, those with depression or some other psychiatric disorder, and those suffering from severe hypermetabolic states such as burns or sepsis, or malabsorption syndromes. Other conditions that may require tube feeding include surgery or trauma to the oropharynx, esophageal fistula, and impaired swallowing such as that which occurs following stroke or that related to neuromuscular paralysis.

There are commercially prepared formulas for tube feeding. Some contain all six necessary nutrients (cardohydrates, fats, proteins, vitamins, minerals, and trace elements) and need no supplement as long as they are given in sufficient volume to meet nutritional and caloric needs. Other types of tube feeding formulas are incomplete and therefore will require some supplementation. Choice of formula is based on the patient's particular needs, presence of organ failure or metabolic aberration, lactose tolerance, gastrointestinal function, and how and where the feeding is to be given, that is, via nasogastric, gastrostomy, or enterostomy tube.

PATIENT CARE. In addition to frequent and periodic checking for tube placement and monitoring of gastric residuals to prevent aspiration, other maintenance activities include monitoring effectiveness of the feeding and assessing the patient's tolerance to the tube and the feeding. Special "mouth care" MOUTH CARE is essential to maintain a healthy oral mucosa.

Gastrostomy

(gas-tros´to-me) the creation of an opening into the stomach. This procedure is done to provide for the administration of food and liquids when stricture of the esophagus or other conditions make swallowing impossible. In the past gastrostomies were carried out in the operating room through an abdominal incision and formal laparotomy. Advances in endoscopic technology have led to techniques of introduction of the tube in a minimally percutaneous manner. Tubes placed in this fashion need special placement and the physician should be consulted before the tube is manipulated.

PATIENT CARE. The patient who is to undergo this type of surgery usually has been ill for some time. He often has nutritional deficiencies brought on by a steadily increasing difficulty in swallowing. Sometimes the patient is a small child who has accidentally swallowed lye or some other caustic substance, or he may be an adult who has taken a corrosive poison in an attempted suicide. Some elderly patients with obstructive carcinoma of the esophagus or throat may also require gastrostomy.

A primary consideration in the care of these patients is the patient's acceptance of the gastrostomy as a substitute for eating. There are many social and emotional factors associated with eating and sharing a meal with others. Health care providers must be sensitive to the problems these patients will encounter in their adjustment to the changes a gastrostomy may bring to their lives. Whenever possible patients are taught self care in preparation of food, the feeding procedure, and peristomal skin care. It is important that they have privacy while doing this and that they be encouraged to ask questions and seek assistance from the members of the health care team.

The skin around the opening must be protected from irritation by the gastric juices, which may leak from the opening and act as a corrosive on the skin. In some cases the gastrostomy tube can be removed after each feeding. A device called the Barnes-Redo prosthesis is available for use by patients with a permanent gastrostomy. This device is designed so that a cap can be fitted over a nylon tube permanently installed in the opening. When food or liquids are to be given the cap is unscrewed and a catheter is passed into the nylon tube. After feeding is completed the catheter is removed and the cap is screwed tightly over the nylon tube.

Feedings for a gastrostomy patient are gradually increased according to tolerance. At first, water and glucose are given at regular intervals. If there is no leakage and the patient has no difficulty with these liquids, other liquids and puréed foods are gradually added until a full meal can be tolerated.
In order to stimulate gastric secretions and aid digestion, these patients should see, smell, and taste small amounts of food before each feeding. It is recommended that they be allowed to chew small bits of food even though they cannot swallow them. This allows for proper stimulation of the gums and teeth and helps promote the health of the mouth and teeth.

Feedings should be warmed before they are given through the tube. Although commercially prepared liquid feedings are more convenient, they often cause diarrhea and are not as nutritionally adequate as regular meals. The foods to be given through the tube should be cooked until they are soft and then puréed in an electric blender. They can be diluted with the water in which they have been cooked, so that no vitamins are lost. A clinic dietitian usually must work very closely with the patient and family, instructing them in the planning and preparation of the patient's meals and offering suggestions for a variety of foods that will provide a well balanced diet.