Understanding Peg Tubes or Feeding Tubes

The problem is not always that a person is unable to tolerate eating. Sometimes people just stop eating. It could be due to a brain injury, or a refusal to eat. I see this mostly in elderly patients. It seems that most people stop eating as they approach the end of life. Their bodys do not require as much energy and a person can last quite a while on iv fluids alone. Some family choose to provide nutrition in these cases.

A feeding tube or Peg Tube is not always a long term intervention. Sometimes a person only needs feeding assistance for a short amount of time. A Nasogastric Tube can easily be used short term or a surgically placed Peg Tube can be removed later.

TPN or parental nutrition means the GI tract does not have adequate function. TEN or entral nutrition means the intestines absorb easily but ingestion is impaired.

Nasogastric Tube or Dobhoff

In easy to understand terms a nasogastric tube is measured from the patients mouth, to ear, and to the stomach. The patient is sitting up and the tube is advanced through the nostril to the stomach stopping at the measured length. The tube is taped into place across the nose. This sounds very easy but the patient often fights or resist the tubing. If the person is able to swallow a small sip of water this sometimes helps the tube go down. A portable chest xray is used to confirm placement. Placement has to be confirmed before feedings can be started. For long term feeding a person may have a NG Tube until surgical placement is done, but not permanently.

Peg Tube

A peg tube is different as it is surgically placed and more permanent. A tube is placed through the abdominal wall for feeding and medication purposes. It is important that the peg tube is maintained and well cared for. Sometimes the skin around the peg tube may get excoriated. Generally 24 hours after placement the area surrounding the peg can be cleaned with normal saline. Dressings should be kept clean and dry around the site.

Continuous Feeding

Continuous feeding means that the peg tube or nasogastric tube is connected to a pump and a measured amount of feeding solution is given all day. The feeding can be stopped and flushed before and after medications are given. It is important that medications be crushed or liquid. A solid pill could easily block up the tube. This is usually the preferred method of feeding.

Intermittent Feeding

Intermittent feedings means that every 4-6 hours a measured amount of feeding solution is pushed through the Peg or NG Tube. Medications can be crushed and given through the Peg or NG Tube flushing before and after.

Aspiration

Now feeding is underway and you don't think aspiration is a risk anymore. Well it is. If a person is not digesting their intake it is possible for the fluids to build up and aspirate into the lungs. You may hear the words "filling up." It is necessary when giving feedings to check for "residual." A large plastic syringe is connected to the tube and fluids in the stomach are pulled up and measured. It may be necessary to slow down, decrease, or even stop feedings. People can live a long time with feeding tubes. Terri Schiavo comes to mind. She lived in a nursing home for many years until her husband fought her family for the right to stop her feedings and allow her to die.

Sometimes a family may decide to stop feedings and let nature take its course. The family may ask that medications only be given through the feeding tubes. I have seen a person live longer than you would think possible on a simple water flush, or iv fluids. One should never push their own values on another family when end of life decisions are made.

For people who require a short term feeding tube they often return to their normal eating habits prior to receiving feeding assistance. It is easier for familys to choose feeding assistance when they know their loved one will recover from their present condition.

Everyone should know more about feeding tubes and make sure their family knows how they feel about them incase they ever need a Peg Tube or Nasogastric Tube. It may be a good idea to put your feelings in writing.

I hope you now have a better understanding of feeding tubes, intermittent, and continuous feeding.