What should I expect from tube feeding?
Your experience will depend on the type of feeding tube you get and why you need it. Your care team may take total responsibility for feedings and cleaning your feeding tube while you’re in the hospital. If you go home with it, you (or your caregivers) may need training on how to use and care for it. You may also need help setting up the equipment to use the tube at home.
Feeding tube placement
Healthcare providers usually insert feeding tubes while you’re in the hospital, but you may continue to use one at home. Tube feeding provided at home is called home enteral nutrition (HEN).
Some placement procedures can happen at your bedside. But if you’ll need a feeding tube for more than a month or so, you’ll need an in-hospital procedure to insert the tube. For these procedures, plan to fast (no eating or drinking) for at least eight hours. You’ll also need to stop blood-thinning medications (anticoagulants), like aspirin, for a while before the procedure. You’ll receive anesthesia and sedation, so you won’t feel pain. Procedures usually take half an hour.
Healthcare providers may insert the tube:
- Nasally: This procedure can happen at your bedside. Using image guidance, your provider will gently insert the tube into your nose and maneuver it through your throat and esophagus until it reaches your stomach. They’ll lubricate the tube and give you an anesthetic to make the procedure painless. They may ask you to sip water through a straw during the procedure to help encourage the tube downward.
- Endoscopically: Your provider will use a long, flexible instrument with a camera (endoscope) to help place the feeding tube. They’ll send the endoscope through your mouth and esophagus until it reaches your stomach. The camera lets them see where to make the tiny cut (incision) into your abdomen to insert the feeding tube. Types of feeding tube placement that use an endoscope include percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic gastrojejunostomy (PEG-J).
- Radiologically: Your provider will use X-rays to help them see where they should cut to insert the feeding tube. Types of feeding tube placement that use X-rays include radiologically inserted gastrostomy (RIG) and percutaneous radiologic jejunostomy (PRJ).
- Surgically: Your provider may perform open surgery, which requires a larger cut into your abdomen, or they may insert the feeding tube using laparoscopy. During a laparoscopy, your provider makes a few tiny cuts into your abdomen. They insert an instrument with a camera (laparoscope) to view your organs. They then insert the feeding tube using the other cuts.
Ask your healthcare provider about the method they’ll use to insert the feeding tube, so you know how to prepare and what to expect.
Using a feeding tube
Some feeding tubes use a syringe or pump to send liquid nutrition from a bag into your body. Other feeding tubes connect to bags that are raised on a pole or hook. Gravity sends the liquid nutrition down through the tube when it’s time to eat.
When you eat depends on various factors, including the type of feeding tube you have. Tube feedings may be:
- Only at mealtimes: This is called bolus feedings. You’ll receive liquid nutrition through the feeding tube during those times of day when you’d typically eat. The upside of bolus feedings is that you eat with regularity, like you would without a feeding tube. Bolus feeding is typically only done with tubes in your stomach, since your stomach naturally stores food and can handle the larger volume.
- Continuous: You’ll need to receive constant, small amounts of nutrition daily if your feeding tube is in your small intestine (duodenum or jejunum). This is because your small intestine isn’t meant to hold large volumes of food at a time.
Your healthcare provider will help you determine the type of formula and how much you need to ensure you’re getting the right amounts of fluids, vitamins, minerals and calories.
Many formulas are available with different concentrations of calories and specific nutrients, like proteins, fats and carbohydrates. Some formulas are specific for certain diseases, such as kidney diseases. Your provider may change the formula based on your tolerance and nutrition needs over time.
They can also advise you on how to receive enteral nutrition safely. For example, they may advise you to sit at a 45-degree angle during feedings and a few hours afterward to prevent complications, like aspiration pneumonia. With aspiration pneumonia, the formula slips into your windpipe and lungs, causing an infection. The way you position your body can prevent this.
Never insert any carbonated beverages into your feeding tube.
Caring for a feeding tube and the insertion site
You’ll need to care for the feeding tube to prevent clogs and clean the skin around the feeding tube to prevent infections.
To care for the insertion site:
- Wash it with soap and water at least once daily but more if you have drainage. You may need to contact your provider if you have drainage. They can provide gauze to help absorb the drainage or barrier creams to help protect your skin.
- Dry the area with a clean cloth between cleanings to discourage bacterial growth. (Bacteria grow in warm, moist environments.)
- Wipe away any crust that forms on a nasogastric (NG) tube (the kind that goes in your nose).
- Alert your provider immediately if you notice signs of an infection (warmth, redness, pain, swelling or pus).
To care for the tube:
- Flush your feeding tube regularly. Flush your tube with warm water before and after feedings to prevent clogs. Flush it before and after receiving medicine through your feeding tube. It’s important to flush it even on days when you’re not using it to eat or take medicines, so you’re keeping it clear. Your provider will demonstrate how to flush your feeding tube before you leave the hospital.
- Have your feeding tube changed regularly. It’s important to have the tube changed regularly to ensure it holds up and works as it should. Some of the tubes with harder plastic at the end need to be changed every year. Other tubes with balloons at the end need to be changed every three to six months. Ask your healthcare provider about when you’ll need to come in so they can make these changes for you.
- Go to an ER if your feeding tube slips out of place. With new tubes in your abdomen, it takes time for the tract between your stomach or small intestine and the outside of your body to mature. This typically takes six to eight weeks. It’s a medical emergency if the tube falls out or is pulled out before that time. Seek medical attention right away.
