What are the types
of tube-feeding?
Two types of tube-feeding are commonly
seen. The first is called the nasogastric tube which is a tube inserted through the
nostril into the stomach. It usually requires changing fortnightly.
The second type is
called gastrostomy tube. This consists of a tube which is inserted through the skin
into the stomach. The advantage of this over the nasogastric tube include infrequent
change (usually six monthly), absence of the discomfort associated with the nasogastric
tube and lastly, the gastrostomy tube can be hidden under clothing when the patient
travels outdoor, thus improving the self-image of the patient.
The only
disadvantage is that the initial insertion must be carried out as a day surgery in the
hospital and this translates to a higher cost. However, for most tubes used nowadays, the
subsequent change can be done at home or as an outpatient by trained personnel. It is
important to mention that not everyone is suitable for the insertion of gastrostomy tube
and a doctor has to be consulted beforehand.
What are the types
of feed available?
These include:
Blended feed:
this is home-made food which has been blended. This is seldom used as it is troublesome to
prepare and this type of feed has a higher chance of causing blockage to the tube.
Commercially
available feed which can provide complete nutrition for the day. This can either be in
the form of ready-made liquid or milk powder. The latter is cheaper but requires
preparation by the care-giver. There are also specially designed feed for patients with
certain medical problems who require adjustment to their diet.
What are the ways of
administering the feed?
Basically, there are 2 ways:
Intermittent
feeding whereby the patient is given bolus feed at regular intervals.
Continuous
feeding whereby the feed is slowly released into the gastric area usually with the aid
of a pump which can control the flow rate of the feed. The advantage of this form of
feeding is that it reduces the workload of the care-giver and it can also relieve some of
the problems of intermittent feeding such as gastric discomfort due to stomach distension.
Important points to
remember during tube-feeding:
Follow the instructions given by the doctor,
nurse or dietician in the preparation of the milk feed and the volume of the feed to be
given. As a general rule, it is not advisable to give more than 300 ml of feed at any one
time for intermittent feeding as this will cause excessive distension of the stomach and
increase the risk of vomiting.
Before each feed,
aspirate the gastric content for two purposes; firstly, to test for presence of acid using
the litmus paper (should turn from blue to red) and secondly, to check the amount of feed
still left in the stomach after the last feed. If the amount of feed aspirated before the
next feed is more than 100 ml and the patient is otherwise well, try increasing the
intervals between each feed. Switching to continuous feed or use of medications to hasten
the gastric emptying may be required.
Sit the patient up
during the feed and for at least half an hour after the feed. If this is not possible,
prop the patient up to at least 30 degrees of inclination. This is to reduce the risk of
the feed regurgitating from the stomach and aspiration, that is, the feed entering the
lungs, in case the patient vomits.
Inform the nurse or
doctor if the patient has vomiting, abdominal distension or diarrhoea.
