Many patients are unable to eat food when they are serious ill or injured. Nutrition may be given though a variety of tubes:

• Intravenous tube which delivers high calorie intravenous nutrition
• A Naso gastric tube that is inserted into the nose and threaded down to the stomach.
• A percutaneous endoscopic gastrostomy tube
• A percutaneous endoscopic jejunostomy tube

• High calorie intravenous nutrition (total parenteral nutrition) is the only option if the gastrointestinal tract is not functioning, which may happen after trauma or surgery. It consists of a potent mix of nutrients used for patients who need long term nutritional therapy.
• A nasogastric tube is used for short term (four to six weeks) nutritional therapy. It delivers fluid, medications, and nutrition into the stomach, and can also be attached to suction to drain fluid out of the stomach.
• A percutaneous endoscopic gastrostomy tube, or a PEG tube, is inserted through the stomach wall into the stomach. It is used for long term nutrition and medication administration.
• A percutaneous endoscopy jejunostomy tube, or PEJ, is inserted through the stomach wall into the jejunum, which is a portion of the gastrointestinal tract below the stomach. It also can be used for long term nutrition and medication administration.

Feeding given into the gastrointestinal tract offers advantages over total parenteral nutrition. There are lower rates of infection, fewer complications, reduced cost and shorter hospital stays. It is more natural, and the body tolerates it better.

Patients who are not expected to be able to eat or have not eaten for at least seven days should receive artificial nutrition either in the form of high calorie intravenous feeding or feeding through a nasogastric tube. Feeding may be started sooner than 7 days and is given due to difficulty swallowing, poor appetite, the intense need for nutrients caused by wounds, burns, or trauma, acute pancreatitis or a fistula (a tunnel from the gastrointestinal tract to the outside of the body or another organ).

Patients who cannot receive nutrition into the gastrointestinal tract are those with acute inflammation of the abdomen, paralyzed or poorly functioning intestines, blockages in the intestines, unrelieved vomiting or diarrhea, or severe gastrointestinal bleeding.

What are the Risks?

Total parenteral nutrition has a high sugar content. It is a perfect breeding ground for bacteria. Contamination of the solution, dressing, or tubing can result in a serious blood stream infection. The standard of care requires the staff to be diligent about sterility and handwashing. We know from observations that staff do not always wash their hands when they should.

A healthcare provider may accidentally insert a feeding tube into the lungs instead of the stomach. This risk is reduced by checking the placement with an x-ray. The standard of care requires verification of placement before using the tube, listening for gastric gurgles, injecting air into the end of the tube to hear it rumble in the stomach, and testing the secretions coming out of the tube. They should be acidic consistent with stomach acid.

Tube feeding solution can back up in the stomach, causing the patient to vomit and inhale the food into the lungs. This can be fatal. The rate of the tube feeding solution may be reduced or held until testing shows no residual left in the stomach between feedings.

Healthcare personnel who fail to check the placement of the feeding tube can assume it is in the stomach when it has slipped into the lung. Tube feeding solution that goes into the lung can be fatal.

A PEG tube can be surgically inserted into the wrong part of the body, a risk that is minimized when the gastroenterologist performing the procedure is skilled.

A PEG tube can be accidentally pulled out. If it is reinserted by a person who fails to confirm it is in the stomach, tube feeding solution can go into the abdomen. This can be fatal. We’ve seen several cases at Med League of nurses who reinserted a feeding tube into the wrong spot and delivered solution into the abdomen.

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