Gavage feeding, also known as tube feeding, is a medical procedure that delivers nutrition and medication directly into the stomach or small intestine. This method bypasses the mouth and throat using a small, flexible tube inserted through the nose (nasogastric) or mouth (orogastric). It is a form of enteral nutrition applied in hospital settings for patients, particularly infants or those who are critically ill, when normal oral intake is either unsafe or impossible.
Understanding the Need for Gavage Feeding
A physician prescribes gavage feeding when a patient’s ability to consume adequate nutrients orally is compromised, but their gastrointestinal tract is still functional. A primary indication is in premature infants who often have an immature suck and swallow reflex, making bottle or breastfeeding too exhausting or dangerous. For these babies, gavage feeding provides nourishment without the risk of fatigue or the potential for aspiration into the lungs.
Adults and older children may require this support due to severe illnesses, major surgery, or neurological impairments that affect swallowing coordination, a condition known as dysphagia. Patients experiencing significant respiratory distress are often unable to feed orally, as the effort of sucking or chewing can interfere with breathing. In such cases, gavage feeding ensures adequate calorie intake to support recovery and growth without expending excessive energy. It is also used for those suffering from a failure to thrive, where they cannot absorb or consume enough calories to maintain a healthy weight.
Detailed Steps of the Feeding Procedure
The procedure begins with the correct placement of a soft, flexible tube. The tube is typically measured from the tip of the nose to the earlobe and then down to the mid-point between the end of the breastbone and the navel. Once gently lubricated, the tube is carefully advanced through the chosen route until the pre-measured mark is reached, ensuring it rests in the stomach. The tube is then secured to the face or cheek with a gentle adhesive before confirming its position.
Confirmation of tube placement is a non-negotiable safety step, most reliably achieved through a chest X-ray in a clinical setting. Other methods involve gently aspirating contents from the tube using a syringe and testing the fluid’s acidity with pH paper; a pH value of 5.5 or lower strongly suggests the tube is in the stomach. Before starting the feed, the formula or breast milk must be prepared and warmed to room temperature to prevent gastrointestinal cramping.
The feed is administered either as a continuous infusion using a pump or as a bolus feeding, which is a larger volume given over a short period. Bolus feeds are delivered using a syringe with the plunger removed, allowing the liquid to flow by gravity over 15 to 20 minutes. Pacing the feed is important to prevent stomach distention and discomfort.
After the feeding is complete, a small amount of sterile water is flushed through the tube to clear any residual formula and prevent clogging. The patient must be kept with their head and shoulders elevated for at least 30 minutes following the feed to aid digestion and minimize the risk of reflux.
Potential Challenges and Management Strategies
While generally safe, gavage feeding presents several challenges, the most concerning of which is the risk of aspiration, where formula enters the lungs due to reflux or improper tube placement. To manage this risk, staff must strictly adhere to checking tube position before every feed and keep the patient’s head elevated to at least a 30-degree angle during and after administration. Recognizing signs of respiratory distress, such as coughing or gasping, requires immediate cessation of the feed.
Feeding intolerance is a common gastrointestinal complication, presenting as vomiting, abdominal distention, or high gastric residual volumes. Gastric residual is the volume of fluid remaining in the stomach from the previous feed, and an excessive amount may indicate delayed emptying, prompting the medical team to hold the feed or adjust the rate. Management strategies include slowing the rate of continuous feeds or reducing the volume of bolus feeds to allow the stomach more time to accommodate the contents.
Mechanical issues with the tube also occur, including displacement or clogging from thick formula or incompletely crushed medications. Displacement requires immediate removal and reinsertion of the tube. Clogs are often managed by flushing the tube with warm water or specialized declogging solutions. Maintaining meticulous hygiene around the tube insertion site is necessary to prevent skin irritation or infection, which is a particular concern with longer-term tubes.