Gastroenterology Book

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Enteral Tube

Aka: Enteral Tube, Feeding Tube, Enteral Tube Feeding
  1. Types: Delivery
    1. Short-term Feeding Tubes
      1. Nasogastric Tube
        1. Most commonly used as is physiologic and allows for large volume bolus feedings
      2. Nasoduodenal Tube (post-pyloric)
        1. Indicated if higher Aspiration Pneumonia risk, gastric dysmotility or obstruction
        2. Requires continuous delivery device
    2. Enterostomy Tube
      1. Indicated for anticipated enteral feeding beyond 4 weeks
      2. Sub-types
        1. G-Tube: Gastrostomy or Gastric Tube
          1. Medication delivery
          2. Feedings may be drip or bolus
        2. GJ-Tube: Combined tube with both Gastric and Jejunal ports
          1. Medication delivery or bolus feeds via gastric port
          2. Drip feeds via jejunal port
        3. J-Tube: Jejunostomy or Jejunal Tube
          1. Requires drip feeds
          2. Bolus feeds result in Osmotic Diarrhea
  2. Complications: General Enteral Tubes
    1. Tube malfunction, obstruction or migration
    2. Aspiration
    3. Nausea, Vomiting and Diarrhea
    4. Gastrointestinal Bleeding
    5. Bowel Obstruction
    6. Provocation of Gastroesophageal Reflux
    7. Increased skin moisture and maceration
    8. Agitation with a greater need for restraints
  3. Adverse Effects: Nasogastric or nasoduodenal Feeding Tubes
    1. Nasal Discomfort
    2. Gagging
  4. Prevention: Complication avoidance with nasogastric and nasoduodenal Feeding Tubes
    1. Periodic confirmation of Feeding Tube (depth marker, Xray)
    2. Flush Feeding Tube with water at each nutrition stop or after drug delivery
      1. Clogged tubes may be cleared with instillation of digestive enzymes dissolved in warm water
      2. Replace persistently clogged tubes
  5. Resources
    1. EMedicine G-Tube Replacement
      1. http://emedicine.medscape.com/article/149589-overview
  6. References
    1. Majoewsky (2012) EM:Rap 2(9): 7
    2. Finucane (1999) JAMA 282:1368 [PubMed]
    3. Li (2002) Am Fam Physician 65(8):1605-10 [PubMed]

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