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Insertion, Types and Care of Enteral Feeding Tubes

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Intestinal Failure

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Abstract

Enteral feeding is appropriate when oral intake is impossible (neurological or oropharyngeal disease) or is insufficient (catabolic state, anorexia or malabsorption). It is considered before parenteral feeding for simplicity, safety, reduction of some complications (e.g. formation of biliary sludge) and cost reasons. It should not be persisted with if the feed is not being adequately absorbed (e.g. short bowel/mucosal disease or intestinal obstruction), if adequate flow rates are not tolerated, if there is a high risk that there is a bowel perforation/leak, if access cannot be maintained or if severe complications (intractable diarrhoea or aspiration pneumonia) occur. Enteral feeding tubes can be inserted via the nose, mouth, pharynx, oesophagus, stomach or small bowel. The insertion procedure may be done at the bedside, or using endoscopic, radiological or surgical methods. Nasogastric tubes (not usually used for more than 4–6 weeks) have to be carefully checked for the position of the tube tip in case of accidental insertion into the lung/pleura. Gastric aspirate pH measurements usually suffice but if doubt, especially if there are neurological problems, then a confirmatory chest radiograph may be needed. Gastrostomies inserted percutaneously should initially be subjected to very low traction (without tension), then after 7–10 days have their internal flange rotated daily (not if a jejunal tube passes through it) and pushed inwards 2–10 cm one a week. If a buried bumper occurs then it may be cut flush to the skin or removed by methods that result in the internal flange re-entering the gastric lumen. When seeing a patient with an enteral feeding tube, it is important to know when the tract was created, how the tube is retained and where the tube tip should be.

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Nightingale, J.M.D. (2023). Insertion, Types and Care of Enteral Feeding Tubes. In: Nightingale, J.M. (eds) Intestinal Failure. Springer, Cham. https://doi.org/10.1007/978-3-031-22265-8_32

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