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Tube Feeding: Indications, Considerations, and Technique

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Principles of Deglutition

Abstract

Tube feeding, as an alternative to eating, conveys nutrition, fluid, and medications safely and reliably to the intestinal tract. This chapter reviews the many ways of establishing and maintaining tube feeding. For a satisfactory outcome, the requesting provider, patient, family, and consultant must understand the indication, purpose, and expectations of this approach. Because tube position determines function, proper selection and placement are discussed in detail. Special attention is given to surgical and percutaneous endoscopic and radiological approaches. Long-term complications are reviewed in detail and a comprehensive approach to management is outlined, with emphasis on the role of a multidisciplinary enteral nutrition team. Position papers and core references are provided.

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Notes

  1. 1.

    “Feeding Disorder” ICD-9 code 783.3 is universally accepted as an indication for tube feeding and encompasses any problem preventing adequate oral nutrition, including severe anorexia, deglutitive failure, or even coma. It does not specify the source of the problem, just its existence. “Feeding disorder” is not “Eating disorder.”

  2. 2.

    A dependent person is rarely isolated; illness brings family; family brings issues. This may be an asset (or not) but it is not going away. The consultant is well advised to address any issues early and openly.

  3. 3.

    Charles Se’dillot, a French surgeon, is the first to report a surgical gastrostomy in a human. Unfortunately, the first long-term survivor of this procedure was not reported until 1870 by LL Staton, a surgeon in North Carolina.

  4. 4.

    Because weighted tubes are still sold one might assume that the weight is effective in moving these tubes forward. The weighting of tubes was an unproven but common feature of tubes made before 1976, the date the FDA began regulating such medical devices. Such “grandfathered” or “preamendment devices” do not require proof of safety or efficacy.

  5. 5.

    An “-ostomy” [Greek, stoma: mouth] is a procedure (surgical, endoscopic, or radiological) to create an opening (e.g., “a colostomy was performed for diverticular disease”). A “-stoma” (pl. stomata) is the opening from the skin into an interior hollow organ, but one rarely hears the terms “gastrostoma” or “colostoma.” These openings are typically referred to simply as “a gastrostomy” or “a colostomy.” Though not strictly correct, this has become the common usage and will be employed here. Similarly, we anglicize the plural to “stomas” or “-ostomies” instead of stomae or –ostomae.

  6. 6.

    http://www.amtinnovation.com/bridle.html cashed by http://www.google.com at Nov 18, 2011 12:31:03 GMT

  7. 7.

    These words have been variously attributed to Jan LA van de Snepschuet, Chuck Reid, and even Yogi Berra.

  8. 8.

    Classically, the trochar is a metal rod sharply pointed at one end by three cut angles (from Fr. trois+carre). Once placed inside a sheath or cannula the trochar–cannula assembly can push through tissue into a body cavity. When the trochar is removed, the hollow cannula provides an opening into the cavity for access or drainage. The trochar–cannula assembly is typically referred to simply as a trochar.

  9. 9.

    Many abbreviations have been used for Trans-PEG jejunal tube and for Direct Percutaneous Jejunostomy, including “PEJ” for both. In 2002, the American Society for Gastrointestinal Endoscopy endorsed “PEG-J” and “D-PEJ”, respectively.

References

  1. Berger JT, Hida S, Chen H, Friedel D, Grendell J. Surrogate consent for percutaneous endoscopic gastrostomy. Arch Intern Med. 2011;171:178–9.

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Professional Society Positions and Core References

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  2. Bergstrom LR, Larson D, Zinsmeister AR, et al. Utilization and outcomes of surgical gastrostomies and jejunostomies in an era of percutaneous endoscopic gastrostomy: a population-based study. Mayo Clin Proc. 1995;70:829–36.

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  3. Wright F, Waring JP, Goldschmid S, Bruno C. A high-risk criteria, not PEG placement, predict early mortality in hospitalized patients who require enteral feedings. Am J Gastroenterol. 1998;93:1649.

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  4. American Gastroenterological Association Medical Position Statement. Guidelines for the use of enteral nutrition. Gastroenterology. 1995;108:1280–031.

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  5. American Society for Gastrointestinal Endoscopy. Technology assessment status evaluation: endoscopic feeding tubes. Gastrointest Endosc. 1995;42:612–4.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA

    William L. Berger MD

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  1. William L. Berger MD
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Correspondence to William L. Berger MD .

Editor information

Editors and Affiliations

  1. Div. Gastroenterology & Hepatology, Medical College of Wisconsin, West Wisconsin Avenue 9200, Milwaukee, 53226, Wisconsin, USA

    Reza Shaker

  2. , Dpt Otolaryngology/Head & Neck Surg., UC Davis Medical Center, Stockton Blvd. 2521, Sacramento, 95817, California, USA

    Peter C. Belafsky

  3. Ctr for Voice, Airway & Swallowing Disor, Department of Otolaryngology, Georgia Health Sciences University, 15th Street 1120, Augusta, 30912, Georgia, USA

    Gregory N. Postma

  4. , Dpt of Communication Sciences & Disorder, University of Wisconsin-Milwaukee, East Hartford Ave 2400, Milwaukee, 53201, Wisconsin, USA

    Caryn Easterling

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Berger, W.L. (2013). Tube Feeding: Indications, Considerations, and Technique. In: Shaker, R., Belafsky, P., Postma, G., Easterling, C. (eds) Principles of Deglutition. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3794-9_68

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  • DOI: https://doi.org/10.1007/978-1-4614-3794-9_68

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  • Online ISBN: 978-1-4614-3794-9

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