Tube feeding

Feeding tubes can be used to provide nutrition while patients are recovering their ability to swallow or, in more serious cases where they are at risk of malnutrition and dehydration.

There are two main types of feeding tubes:

• a tube that is passed down the nose and into the stomach (nasogastric or NG tubes)
• a tube that is surgically implanted directly into the stomach (percutaneous endoscopic gastrostomy tube [PEG]), or small intestine (percutaneous endoscopic jejunostomy tube [PEJ])

(A third method, intermittent oroesophageal [IOE] tube feeding, has also been piloted successfully⁴⁴ as an alternative to continuous nasogastric tube feeding in acute stroke patients with severe dysphagia.)

Nasogastric tubes are designed for short-term use, usually up to six weeks, whereas PEG/PEJ tubes are designed for long-term use and last for around two years before they need to be replaced. PEG/PEJ tubes have a further advantage in that they can be easily hidden under clothing. However, they carry a greater risk of complications⁴⁵.

Minor complications of PEG/PEJ tubes include:

• tube displacement
• skin infection
• tube blockage
• tube leakage

Major complications of PEG/PEJ tubes include:

• internal bleeding
• infection

People who have PEG/PEJ tubes may also find it more difficult to resume normal feeding compared with those who use nasogastric tubes. This may be because the convenience of PEG/PEJ tubes means people who use them are less willing to carry out swallowing exercises and dietary changes compared to people who use nasogastric tubes.

Although there is evidence for PEG/PEJ resulting in better nutrition than NG among dysphagic patients, neither PEG/PEJ nor NG has an effect on the development of aspiration. PEG/PEJ tubes prevent food from lodging in the respiratory tract, but they cannot prevent saliva or gastric content from doing the same⁴³.

Low or oesophageal dysphagia may be treatable with medication or surgery. For example, proton pump inhibitors (PPIs), which are used to treat indigestion, may improve symptoms caused by narrowing or scarring of the oesophagus.

Practitioners should note that most medicines are not licensed for administration via enteral feeding tubes and in these circumstances the prescriber and practitioner accept any liability for any adverse effects resulting from the administration of that drug. However, a small but growing number of oral solutions from Rosemont Pharmaceuticals – furosemide, ramipril, metoclopramide hydrochloride and clonazepam (as of June 2016) – are now approved for administration via NG or PEG tubes.