Types of Enteral Feeding Tubes

Nasal Feeding Tubes

Nasogastric (NG) Tube: Runs from the nose, down the esophagus, and into the stomach. They are typically used for short-term feeding (4-6 weeks) and do not require surgery to place or remove the tube. Usually, a nurse in a hospital will place the tube and it will be replaced every 3 days to four weeks. If you are leaving the hospital with NG tube, your nurse will most likely show you how to replace the tube yourself and what to do if accidental dislodgment occurs.

Nasoduodenal (ND) Tube & Naso jejunal (NJ) Tube: Like the Ng tube, these tubes are placed through the nose and do not require surgery. Both Nj tubes and Nd tubes extend from the nose, past the stomach, and into the small intestine. Nd tubes end in the duodenum (the first part of the small intestine) and Nj tubes end in the jejunum (the middle part of the small intestine). These types of tubes are used if the stomach cannot handle feeding. These tubes must be placed by a trained technician and cannot be replaced at home. If accidental dislodgment occurs, contact your healthcare team.

Surgically Placed Feeding Tubes

Surgically placed feeding tubes are used for long-term feeding or when nasal tubes are not an option. These tubes are inserted through a small incision in the abdomen during a minimally invasive laparoscopic procedure. The incision creates an opening called a stoma, which, once healed, is generally pain-free and does not interfere with daily activities.

Percutaneous Endoscopic Gastrostomy (PEG Tube): Typically, the first type of tube recommended when needing long-term enteral feeding. The tube is surgically inserted into the abdomen and through the stomach. It’s secured inside with a balloon or mushroom-shaped tip and outside with a bumper or disc. PEG tubes stick out of the stomach and can stay as long as they’re needed

Gastronomy Tube (G-tube): Similar to PEG tubes, as they are also Inserted directly into the stomach. However, G-tubes have balloon inside the stomach prevents the tube from slipping out, while a small disc on the abdomen holds it in place. The G-tube has a feeding port for administering nutrition. They are usually placed after receiving a PEG tube and the stoma site has healed fully. However, in some cases G-tubes may be placed initially without placing a PEG first. G-tubes can be either standard-length or low-profile, which means the tube lies close to the skin. Once fully healed and given approval from your healthcare team, low-profile and standard-length g-tubes can be replaced at home.

Jejunostomy Tube (J-tube): Inserted directly into the small intestine through an abdominal incision. This tube bypasses the stomach entirely and leads directly to the part of the small intestine called the jejunum. Like G-tubes, J-tubes can be a standard-length tube called a dangler, or a low-profile tube called a button. These tubes are recommended for many reasons including preventing reflux and other digestive issues. These tubes are placed by a variety of procedures and cannot be replaced at home.

Gastrojejunal Tube (GJ-Tube): This is a combination of G-tubes and J-tubes. A GJ-Tube goes through the abdomen and into two both the stomach and the small intestine (jejunum). GJ-tubes are often used if the stomach does not empty properly, leaks food or liquid back into the esophagus, or poses a risk of aspiration (inhaling food or liquid). Like both G and J tubes, it is held in place by a ballon filled with water. It has 3 ports on the outside for different purposes:

Gastric Port: For medications, fluids, or removing excess stomach air.
Jejunal Port: For feeding directly into the small intestine.
Balloon Port: To add or take away water from the ballon to prevent accidental dislodgment.

Types of Enteral Feeding Pumps

Feeding pumps are devices that deliver nutrients, medications, antibiotics and fluids. Choosing the right feeding pump for your needs is extremely important and should be done with your healthcare team. Nutrition from pumps can be administered in two ways:

Cycled feeding: This is used when feedings run for a part of the day.
Continuous feeding: The tube feedings run continuously for twenty-four hours.

The Infinity Enteral Feeding Pump: The Moog Infinity pump is the most common feeding pump. It is small, lightweight, and can be run in any position. This easy-to-use pump is made for both pediatric and adult patients to get the nutrition they need daily.

The Infinity Orange Small Volume Enteral Feeding Pump: This enteral-only feeding pump is perfect for when precise delivery of small volumes of milk or formula is required. This pump by Moog is simple to program and made for infants.

The Kangaroo OMNI: This feeding pump by Cardinal Health is larger and heavier than the Moog pumps but has a wider variety of features.

The Kangaroo Connect: This enteral feeding pump has wireless connectivity aimed to minimize interruptions in your feeding schedule.

Gravity & Bolus Feeding

Gravity feeding is a simple and convenient way to deliver nutrition without the use of a feeding pump. Instead, liquid nutrition is put into the feeding bag, which is hung above the patient, usually by an Iv pole, allowing the liquid to flow down the tube by the force of gravity. The rate of the feeding is controlled by a roller clamp on the tube & some gravity bags have a drip chamber which gives a visual to monitor the rate of the formula.

Bolus Tube Feeding is a method of feeding that delivers a large amount of formula through a feeding tube over a short period of time using a catheter syringe. A catheter syringe has a hole but no needle. You pull formula into the syringes hole and push the formula into your feeding tube with the plunger. Individuals who are able to tolerate a normal amount of food at one time can use bolus feeding. These feedings are given every 4 to 6 hours (during waking hours).

Tips for giving Bolus feedings:

Flush the feeding tube with recommended amount before and after each feeding.
Don’t let the syringe get completely empty during the feeding. Air may get into the stomach and cause discomfort.
Clean the syringe thoroughly between feedings & use the same syringe and adapter for no more than 2 weeks.
If you want to speed the feeding rate, raise the syringe higher. If you want to slow the feeding rate, lower the syringe. The higher above the syringe is the faster the formula will move.

Other Enteral Feeding Supplies

Syringes: Come in a variety of shapes and sizes, for various purposes. Smaller syringes, like10 ml are used to flush tubes and administer medications. Larger syringes, like 60 ml are used to give bolus feedings.

Extension Sets: Are used for the MIC-KEY low-profile feeding tubes. They are used to deliver nutrition, fluids, medications and for venting. They can come in multiple lengths and configurations such as having a ENFit or Non-ENFit connector. One end of the set will be attached to the feeding pump, and the other will be attached to your feeding source(s) such as a pump, syringe or feeding set. Your healthcare team will determine if it is best for you to use a bolus, a continuous set or both. A continuous set Follow their instructions on how to use and care for it. Detach the extension set when not in use

Feeding Pump Bags: Connect to a feeding tube to deliver nutrients, fluids and medications at a controlled rate.

Enteral Backpack: These bags are made to fit a feeding pump and all the supplies needed for feeding while on the go.

Micropore: A paper tape that comes off easily when wet. It is a versatile adhesive and is commonly used for securing G-tube or GJ-tube extension sets to the skin.

Medipore: A cloth tape that is flexible, breathable. It is a pre-perforated adhesive, so no scissors are necessary.

Tegaderm: A transparent film dressing that can be used to cover and protect NG/NJ tubes, catheter sites, wounds. Tegaderm is commonly applied on top of the tube and Duoderm.

HY tape: A non-breathable waterproof tape that works well for sensitive skin and for taping NG-tubes.

Gauze: A thin translucent fabric of silk, linen, or cotton used to care for the stoma site. Gauze is commonly used to dress new stoma sites, which can be irritated and oozy after surgery. This helps keep the area clean and dry, preventing granulation tissue.

Duoderm: A dressing that applies directly to the skin for an NG/NJ tube to lay on. The tube is commonly secured to the Duoderm by a piece of Tegaderm.

Cotton Swab: Commonly used to clean the stoma site and can be used to help clean feeding pumps.

Lube: Water soluble lubricant can help when replacing feeding tubes in the home.

PH Strips: Used to ensure correct placement of a feeding tube in the stomach. The process involves drawing gastric fluid by syringe and testing the aspirate for acidity using a pH strip.

Stethoscope: Used to ensure correct placement of an NG tube. This process involves listening for a whooshing sound as air enters the stomach by placing a stethoscope over the patient’s upper abdomen while instilling a 30-cc air bolus using an irrigation syringe.

Enteral Feeding Formulas

Enteral nutrition provides a liquid food mixture designed to meet your body’s nutritional needs, including proteins, carbohydrates, fats, vitamins, minerals, and other essential nutrients. These formulas are specially created to ensure proper nutrition for individuals who rely on tube feeding.

Feeding formulas come in various forms to suit different medical needs and personal preferences. They may be:

Ready-to-feed: Pre-mixed and ready for immediate use.
Powdered or concentrated: Require mixing with water before use.
Blenderized: Made from real, whole foods. Can be made at home or pre-packaged.

Types of Feeding Formulas

Different types of formulas cater to specific dietary and medical requirements:

Standard Formulas: Contain a balanced mix of nutrients, ideal for individuals with normal digestion.
Elemental Formulas: Made with nutrients already broken down for easy absorption, designed for people with digestive or absorption issues.
Semi-Elemental Formulas: Partially broken-down nutrients, suitable for those who need easier digestion but don’t require fully pre-digested options.
Specialized Formulas: Tailored for specific medical conditions, such as diabetes, kidney disease, or allergies.

Choosing the Right Formula

Selecting the right formula is essential to ensure your nutritional needs are met and to support your overall health. Your healthcare provider or dietitian will recommend a formula based on factors such as:

Medical conditions
Digestive capabilities
Caloric and nutrient requirements
Personal preferences

The goal is to find a formula that meets your nutritional needs while being easy to tolerate and incorporate into your feeding routine. Always consult your healthcare provider before making changes to your formula or feeding regimen.

Proper care and maintenance of your stoma site and enteral feeding supplies are essential for ensuring effective feeding, preventing complications, and maintaining your overall health. By following recommended guidelines and staying vigilant about cleanliness, storage, and monitoring, you can reduce the risk of infections, clogs, and other common challenges. Below, we’ll break down the key aspects of care and maintenance, offering practical tips and solutions.

Stoma Site Care

The stoma site requires consistent attention to prevent infections, skin irritation, or discomfort. Here’s what you need to know:

Clean Hands: Before touching the stoma site, make sure you always wash your hands thoroughly.
Daily Cleaning: Gently clean the stoma site using gauze or a cotton swab with mild soap and water. Remove any drainage crust and rinse with clean water and pat dry. Make sure to dry under the external bumper and around the tube. Avoid using harsh chemicals unless directed by your healthcare provider. Do not submerge the stoma site in water until the wound is healed (around 2 weeks).
Tube Rotation: Do not attempt to rotate the tube if it has been stitched in place. If the gastrostomy tube has not been stitched in place, do not rotate the tubes until after 2 weeks and then once the site is healed rotate the tube gently 360 degrees each day to prevent scar tissue from forming.
Dressing Changes: Dressings are not normally required following the insertion of a gastrostomy tube. Never place dressings under the bumper even if there is ooze; this places unnecessary pressure on the gastrostomy site and can lead to complications.

Care and Maintenance of Enteral Feeding Supplies

Feeding Tube Maintenance

Tube positioning: Always confirm tube positioning prior to use. When connecting the extension set/syringe to the feeding tube, do not apply excessive force or over-tighten the connectors. In most instances, 1/4 turn is sufficient to connect the ends together. Ensure your child’s head is elevated (minimum 30 degrees) during the feeding and for at least 30 minutes after the feeding. If your gastrostomy tube has a balloon, confirm how much water is meant to be in your balloon. Check the water volume in the balloon per the manufacturer/health care professional’s instructions.

G-tube Fit: When your child starts gaining weight, the length of the G-tube will need to be increased. Be sure to evaluate the fit of the G-tube daily, when cleaning the stoma site. Too tight: The G-tube is too tight when it is pressing into the skin, leaving no room in between the skin and the G-tube. If this occurs, contact your doctor to evaluate if you need a longer size. Too loose: The G-tube is too loose when there is extra room in between the skin and the G-tube when gently lifting, leading to more leaking than usual. If this occurs, contact your doctor to evaluate if you need a shorter size.

Cleaning and Sterilization: Keeping Supplies Safe

Enteral feeding has a risk for infection due to potential bacterial infection from formula and feeding supplies. Keeping feeding supplies clean is crucial for avoiding contamination. It is essential to regularly replace feeding supplies to minimize the possibility of infection.

Syringes: Use a new syringe every 1 to 2 days to prevent bacterial buildup and infections. After each use, rinse syringes thoroughly with warm, soapy water and air-dry them in a clean area. Do not put syringes in the dish washer.
Feeding Bags: Rinse with warm water after each feeding & replace after 24 hours.

Feeding Tubes: Flush your feeding tube with warm water and a catheter tipped syringe before and after each feeding or medication administration to prevent clogs & bacterial growth. A minimum daily flush of 60 ml of water helps maintain tube patency.

Feeding Pumps: Should be cleaned and serviced based on the manufacturers guidelines to ensure it remains functional.
Feeding Sets: Clean with mild soap and warm water. It is recommended that sets be replaced every 3 days.
Extensions & Adapters: Should be cleaned with mild soap and warm water. It is recommended that they be replaced every month.

Storage for Supplies and Formula

Formula Storage: Store unopened formula cans at room temperature in a cool, dry area. Once opened, cover and refrigerate the can, discarding any unused formula after 24 hours.
Equipment Storage: Keep supplies in a clean, dry, and organized space. Avoid exposing them to excessive heat or humidity, which could degrade their quality and spread bacteria.

Complications & Side Effects

If you experience any complications, reach out to your healthcare team so they can take action and prevent worsening. Complications and problems can arise due to various reasons such as improper feeding rate, infection from unclean supplies, improper stoma site care and more. This is why it is essential to learn about the supplies you are using daily and the proper ways to clean and maintain them. Here are possible complications to look out for and what to do when these issues occur:

Tube Clogging: To prevent your tube from clogging up, always flush it with water before and after feeding or medications. When flushing your tube ensure the water volume matches your provider's recommendations. If a clog occurs, use warm water and gentle pressure with a syringe to attempt clearing it. Avoid using sharp objects to unblock the tube.

Accidental Dislodgement: If your tube comes out, you must act quickly as the stoma can begin to close. Follow these 6 steps:

Wash the tube or use a new tube and place it back in the stoma.
Do not inflate the balloon.
Tape the tube to the abdomen to secure it in place.
Do not use the tube to give any medications or feedings.
Go to the nearest emergency room to have the G-tube replaced and/or confirm proper placement of g-tube.
If needed, contact your doctor and make a follow-up appointment.

Constipation: If you are experiencing problems with constipation confirm your daily water intake. Check any medications for possible side effects related to bloating and constipation. Talk to your doctor about changing the formula to one with more fiber.

Diarrhea: If diarrhea occurs for more than 24 hours, contact your doctor. Check any medications for possible side effects related to bloating and constipation. Talk to your doctor about changing the formula. Ask your doctor about formula with specialized ingredients to support absorption and tolerance.

Bloating: This can occur after feeding or overfeeding and cause discomfort and/or gas. Your child’s stomach may look swollen or feel hard to the touch. If this occurs, try venting the G-tube: Attach a 60 ml open (with the plunger removed) syringe to the feeding tube or extension set, if your child has a button. Pour a little water into the syringe and hold the syringe below your child’s stomach, then unclamp the tube or extension set to let the air escape. The water should bubble. After the air escapes, let any stomach contents/formula slowly go back into the stomach. Lastly, re-clamp the feeding tube or take off the extension button set.

Leakage: A small amount of leakage/drainage around the stoma site is normal. Be sure to clean the stoma site normally. If leakage continues or causes severe skin irritation, contact your healthcare team.

By staying proactive and following these steps if complications occur, you can navigate enteral feeding with greater ease and confidence. Regular communication with your healthcare team is key to addressing concerns and ensuring the best outcomes.

Nausea or Vomiting: If you experience nausea or vomiting when tube feeding, follow these tips & contact your doctor if symptoms persist.

Begin feeding at a slower rate, then increase the rate gradually over 24-48 hours.
Ensure the formula is not spoiled or contaminated.
Confirm tube placement before feeding.
Ensure your head is elevated (minimum 30 degrees) during the feeding and for at least 30 minutes after the feeding.
Make sure the formula has reached room temperature before administering.
Check any medications for possible side effects related to abdominal pain.

Benefits of Reliable Enteral Feeding Supplies

Improved Health Outcomes: Reliable feeding tubes and accessories are less prone to leaks, dislodgement, or clogging, which helps prevent infections and potential complications.

Consistency in Nutritional Delivery: Durable and well-functioning supplies ensure accurate and consistent administration of nutrition.

Reduced Anxiety: Knowing that your equipment is reliable allows you to focus on care rather than worrying about malfunctions or emergencies.

Streamlined Daily Routine: Reliable supplies simplify the feeding process, making it easier to integrate tube feeding into daily life without disruptions.

Resources for Support

Navigating the world of enteral feeding can feel overwhelming, but there are many resources available to provide guidance and encouragement.

Healthcare Providers: Dietitians, nurses, and specialists are essential for guidance.

Online Communities: Platforms like Tubie Talk and social media groups offer shared experiences and advice.

Educational Materials: Manufacturer guides and video tutorials provide practical tips.

Managing enteral feeding may seem overwhelming at first, but with the right knowledge, tools, and support system, it can seamlessly integrate into daily life. Understanding your feeding equipment, maintaining proper hygiene, and addressing potential complications proactively are essential for promoting health and comfort. Whether you're at home, traveling, or engaging in activities, preparation and care make all the difference.

Remember, your healthcare team and support resources are here to guide you every step of the way—ensuring that you navigate your tube feeding journey with confidence and ease.

Resources

https://www.nestlehealthscience.us/mytubefeeding/tube-feeding-education

https://iuhealth.org/find-medical-services/enteral-nutrition

https://my.clevelandclinic.org/health/treatments/21098-tube-feeding--enteral-nutrition

https://www.tubietalk.com/care-maintenance

https://oley.org/page/CleaningChangingTube

https://together.stjude.org/en-us/medical-care/clinical-nutrition/bolus-feedings-through-feeding-tube.html