A feeding tube is a specialized medical device used to deliver liquid nutrition, fluids, and medication directly into the stomach or small intestine, bypassing the mouth and throat. This is necessary when a person cannot safely or adequately consume enough food by mouth to meet their body’s needs. Understanding the different tube types, the placement procedure, and the proper maintenance steps can help clarify what to expect and empower individuals to manage this change in their care routine.
Understanding Tube Types and the Placement Process
Feeding tubes are categorized based on whether they enter through the nose or are placed directly into the abdomen. Temporary tubes, such as the Nasogastric (NG) tube, are thin, flexible catheters inserted through the nostril, down the throat, and into the stomach. A Nasojejunal (NJ) tube follows a similar path but extends past the stomach into the small intestine. These nasal tubes are used for a short duration, usually less than four to six weeks.
For longer-term nutritional support, tubes are surgically or endoscopically placed directly through the abdominal wall. The Gastrostomy (G-tube) is inserted into the stomach, and the Jejunostomy (J-tube) is placed into the small intestine. A Gastrojejunostomy (GJ-tube) is a variation that enters the stomach but extends into the small intestine. This allows the stomach to be vented or drained while feeding occurs further down the digestive tract.
The insertion method varies significantly between the two main types of tubes. NG tubes are often placed at the bedside using image guidance, a process that is quick and does not require sedation. In contrast, the placement of G-tubes and J-tubes is a more involved procedure, performed in a hospital setting using endoscopy, radiology, or open surgery. The most common method, a Percutaneous Endoscopic Gastrostomy (PEG), involves using an endoscope to guide the tube into the stomach and create a small opening, called a stoma, on the abdominal surface. This procedure usually requires sedation or general anesthesia.
Addressing Discomfort During Insertion and Use
The discomfort associated with a feeding tube depends on whether the experience is related to the acute placement or the chronic daily use. During the placement of an NG tube, the primary sensation is not sharp pain but significant discomfort, often described as gagging, choking, or a sore throat as the tube passes down the esophagus. Healthcare providers lubricate the tube and coach the patient to swallow small sips of water to help the process.
Placement of abdominal tubes, such as a G-tube, is performed under sedation or general anesthesia, so the patient does not feel the insertion itself. Following the procedure, the patient will experience post-operative soreness at the stoma site for several days, often described as feeling like a pulled muscle. This acute pain is managed with medications during the initial recovery period.
Once the tube is in place and the insertion site has healed, ongoing discomfort is minimal. Patients with nasal tubes may feel constant irritation in the nose and throat, which can lead to tissue breakdown or sinusitis if the tube is in place for too long. For abdominal tubes, the most common discomfort is a mild pressure or tenderness at the stoma site. Leakage of stomach contents or formula around the tube can also cause skin irritation and burning, requiring proactive skin care.
Essential Daily Care and Troubleshooting Common Issues
Maintaining the stoma site is important to prevent infection and irritation when living with a G-tube or J-tube. The skin around the stoma should be gently washed daily with warm water and a mild, non-perfumed soap, and then patted completely dry. The site must be visually inspected every day for signs of infection, such as increased redness, warmth, swelling, or pus-like drainage.
Some yellowish mucus or a small amount of drainage is normal, but excessive or foul-smelling discharge should prompt a call to a healthcare provider. Over time, many people develop granulation tissue, which appears as moist, pink, or red bumpy tissue around the stoma. This benign tissue can be managed by a clinician, sometimes using silver nitrate to reduce its size.
Proper tube maintenance ensures the continuous and safe delivery of nutrition and medication. The tube must be flushed with water immediately before and after every feeding and medication administration. If a person is receiving continuous feeding via a pump, the tube should be flushed every four to six hours to prevent formula from sticking to the inner walls.
When administering medications, use only liquid forms or thoroughly crushed and dissolved tablets, as thick substances can easily cause blockages. The tube should also be securely taped or fastened to the body with some slack to prevent dislodgement.
- Medications should be given one at a time.
- Use a small water flush in between each dose.
- Never mix medications directly with the nutritional formula.
Troubleshooting Tube Blockages
Despite diligent care, some common issues may arise that require specific troubleshooting steps. Tube blockages are frequent, often caused by inadequate flushing or medication residue. If a blockage occurs, attempt to clear it by gently pushing and pulling warm water with a syringe. Take care not to use excessive force or sharp objects, which could puncture the tube. If the obstruction cannot be cleared with water, contact a healthcare provider for further instructions, as they may suggest using special enzyme solutions.
Managing Gastrointestinal Side Effects
Gastrointestinal side effects are common, particularly nausea, vomiting, or diarrhea, and these are often related to how the formula is delivered. Delivering the formula too quickly (bolus feeding) or using formula that is too cold can cause digestive upset. To manage this, the feeding rate should be slowed down, and the formula should be allowed to warm to room temperature. The patient should remain seated upright at a 30 to 45-degree angle during the feed and for 30 to 60 minutes afterward.