A feeding tube, also known as an enteral access device, provides a secure pathway for delivering sustenance directly into the gastrointestinal (GI) tract. This method is required when a person is temporarily or permanently unable to take in adequate nutrition and fluids safely by mouth, often due to difficulty swallowing or an impaired digestive system. The primary function of these flexible tubes is to bypass the oral cavity and pharynx, ensuring liquid formulas, water, and medications reach the stomach or small intestine. The specific insertion technique depends on the intended duration of use and the tube’s final destination within the digestive system.
Categorizing Feeding Tubes by Access Route
Feeding tubes are categorized by their access route: non-surgical temporary access and direct surgical access. Nasal or orogastric tubes, such as Nasogastric (NG) or Nasojejunal (NJ) tubes, are inserted through the nose or mouth. They are typically used for short-term nutritional support, generally less than four to six weeks.
The second category involves direct or stomal tubes, which are placed through the abdominal wall into the stomach (G-tubes) or small intestine (J-tubes). These tubes are designed for long-term enteral feeding. Placement requires a procedure that creates an opening, or stoma, bypassing the upper digestive tract entirely.
The Procedure for Nasal Tube Insertion
Placement of a nasal tube, such as an NG tube, is a common non-surgical procedure often performed at the patient’s bedside. The patient is positioned upright, usually in a high Fowler’s position, to aid the tube’s descent. The clinician determines the correct length using the “NEX” measurement: measuring from the tip of the nose, to the earlobe, and down to the xiphoid process.
Once measured, the tube tip is lubricated with a water-soluble gel to reduce friction and trauma. The tube is gently advanced through the selected nostril, aiming toward the ear to follow the nasal floor’s natural curve. When the tube reaches the back of the throat, the patient is instructed to tuck their chin toward their chest and begin sipping water or dry swallowing. This action closes the epiglottis over the trachea, guiding the tube into the esophagus and preventing accidental entry into the lungs.
The tube is advanced with each swallow until the predetermined length mark reaches the nostril. If the patient coughs, gags excessively, or shows signs of respiratory distress, the tube must be immediately withdrawn and the procedure paused. Successful insertion means the tube has traveled down the esophagus and into the stomach, typically taking only a few minutes.
The Procedure for Direct Abdominal Access
Placement of a direct abdominal feeding tube, most commonly the Percutaneous Endoscopic Gastrostomy (PEG) tube, is a sterile procedure performed under sedation or local anesthesia. The patient must fast beforehand to ensure the stomach is empty. The procedure begins with inserting a flexible endoscope through the mouth and down into the stomach to visualize the internal gastric wall.
The stomach is inflated with air through the endoscope. A light on the scope is used to transilluminate the abdominal wall, locating a safe insertion site free of major blood vessels. Once the optimal spot is identified, a small incision is made in the skin after local anesthetic is administered. A needle is then inserted through the incision and into the stomach cavity, confirmed by visualization through the endoscope.
The most frequent technique is the “pull” method. A guidewire is threaded through the needle, grasped by a snare passed through the endoscope, and pulled out through the patient’s mouth. The PEG tube is attached to this guidewire and pulled back down the esophagus, through the stomach, and out of the incision site on the abdomen. An internal bumper rests against the stomach wall, while an external fixation device holds the tube securely in place on the skin.
Post-Insertion Confirmation and Stabilization
Confirmation of the tube’s correct position is the final step before feeding begins. For nasal tubes, the safety standard requires a chest X-ray to confirm the tube tip has safely passed into the stomach or small intestine and has not entered the respiratory tract. While bedside checks, such as testing the pH of gastric aspirate (typically pH 5.5 or lower), offer supportive evidence, radiographic confirmation is mandatory prior to the first use.
For direct abdominal tubes, the internal bumper’s position is verified endoscopically during placement. Once secured, the external fixation device is adjusted to rest lightly against the skin without causing excessive pressure on the stoma site. Initial site care involves applying a sterile dressing around the entry point to protect the newly formed tract.