When the body's natural immune system is weakened, as it is with any chronic illness
or trauma, it is particularly important that the patient maintain good nutritional habits. Eating both the right amounts and
right types of food will give the patient carbohydrates, protein, fat, and other nutrients that will help give them strength
and may improve their ability to fight infection.
When the patient's dietary needs cannot be met by a regular well balanced diet, it
may be recommended the patient be placed on alternative means of nutritional support. Nutritional support options range
from blended food products to commercial formulas, which are taken by mouth or by a feeding tube. The physician will choose
the most appropriate route for nutritional support based on each patients gastrointestinal function, physical capability,
and degree of cooperation.
Placement of a feeding tube does not always mean that eating by mouth is over but
supplementation is necessary for proper nutrition and health.
A feeding tube can be short or long term and must be discussed with a physician
and a nutritionist. A feeding tube must be cared for and the spot where it is placed is prone to infection or irritation.
The excess movement involved in HD may cause the feeding tube to become tender
or even loosened. Aspiration can still occur with a feeding tube in place, so make sure the head is above the level of the
tube to keep this from happening.
Enteral Nutrition means the formula is given to the patient through a feeding tube
directly into the digestive tract. If the patient has a functioning gastrointestinal tract and cannot be sustained nutrition-ally
through oral feedings, they must rely on Enteral feeding. This nutritional support must be ordered by a physician and considered
reasonable and necessary.
WHEN DO YOU CONSIDER A FEEDING TUBE?
Progression must be considered when making the decision. If the patient is at the
end of their struggle and cannot utilize nutrients a feeding tube may not be helpful.
If the above listed techniques for safe swallowing are not successful a feeding
tube may be considered. A physician will not place a feeding tube if all attempts at feeding by mouth have been exhausted.
In some cases placing the tube can be detrimental and may not be the best decision.
Here are some times when feeding tubes may be needed:
- severe nutritional problems
- severe dehydration
- aspiration pneumonia on several occasions
- great fear of suffocation from choking or aspiration
Types of Feeding Tubes
There are several types of feeding tubes:
G Tube/PEG Tube - This tube goes directly in the stomach (percutaneous =through the skin; endoscopic
gastrotomy=stomach tube). The G-Tube
is designed to provide a convenient access route for the delivery of long term Enteral Nutrition. It is surgically placed
into the abdominal wall. The tube is located below the rib cage and slightly off to the left. The skin surrounding the tube
should be kept clean and dry, and in some instances covered with a gauze dressing.
A benefit of the G-Tube is ease of replace-ment, patient comfort and convenience
of care. The most popular tubes are the all *silicone Foley type feeding catheters and the button tube. Other tubes
available are the Mushroom, MIC, PEG, and Malecot tube. The French size and Balloon size are needed when placing an order
for a G-Tube.
A typical complication of the G-Tube can be the moderate amount of gastric leakage.
Gastric juices are highly corrosive and can cause skin irritation.
* However, Foley catheters are used primarily for urinary applications and are not
appropriate or recommended for tube feeding.