“If the gut works…use it.” – This is the theory behind enteral nutrition.
Enteral nutrition, commonly known as tube feeding, is commonly used in patients who can not obtain nutrition or food by swallowing on their own. Enteral nutrition is a generally safe technique to provide nutrition to individuals who have a well-functioning gastrointestinal system.
Indications for enteral feeding
- Impaired nutrient ingestion – neurologic disorders, facial/oral/esophageal trauma, respiratory failure, cystic fibrosis, traumatic brain injury, anorexia and wasting with severe eating disorders
- Inability to consume adequate nutrition orally – hyperemesis, burns, congenital heart disease, anorexia in congestive heart failure/cancer/COPD, spinal cord injury
- Impaired digestion, absorption, metabolism – severe gastroparesis, inborn errors of metabolism, Crohn’s disease, short bowel syndrome
- Severe wasting or depressed growth – failure to thrive, sepsis, cerebral palsy
Types of feeding tubes
1.) Nasogastric Tube (NG Tube) – An NG tube is passed through the nares (the nostrils) and down the esophagus and into the stomach. NG tubes are typically for short term use (3-4 weeks).
2.) Nasoduodenal/Nasojejual Tube – This feeding tube goes through the nose and is placed post-pylorically in either the duodenum or jejunum. This is for patients with gastric motility disorders, esophogeal reflux, or persistent nausea and vomiting.
3.) Gastric Feeding Tube (G-Tube) – A tube inserted through a small incision in the abdomen into the stomach and is used for long-term enteral nutrition (at least 4 weeks). A specific type of G-tube is a PEG tube (Percutaneous Endoscopic Gastrostomy), in which a tube is placed endoscopically through the abdominal wall and into the stomach.
4.) Jejunostomy Feeding Tube (J-Tube) – A tube surgically inserted through the abdomen and into the jejunum.
Classifications of enteral feeding formulas
Contraindications to enteral feeding
- Obstruction of the intestines
- Paralytic ileus
- Protracted vomiting/diarrhea
- Acute bowel ischemia with peritonitis
- High-output fistulas
- Acute severe pancreatitis
- If the patient can meet nutritional needs orally
Benefits of enteral nutrition?
- Safer and more cost-effective than parenteral nutrition (intraveneously delivered nutrition)
- Preserves the mucosal integrity of the GI tract
- Immunological effects
- Reduces septic complications
- Microbial contamination
- Tube displacement
- Refeeding syndrome
- Glucose intolerance
- Pressure ulcers