Enteral Feeding
(Tube Feeding)
How to Say It: EN-ter-al FEED-ing
Definition
Enteral feeding delivers nutrients through a tube when a person cannot take food or drink through their mouth. Some people may only need tube feeding for a short period of time. Others may need to go home with the tube in place and keep getting nutrients this way. It may be temporary or permanent.
The tube may lead from the:
- Nose to the stomach—nasogastric
- Belly wall to the stomach— gastrostomy
- Belly wall to the intestines— enterostomy
Gastrostomy Tube
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Reasons for Procedure TOP
Tube feeding is done to provide nutrition when a health problem makes it hard, unsafe, or not possible to take food by mouth. Fluids and medications can also be given through the tube.
Possible Complications TOP
Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:
- Breakdown of the skin around the feeding tube
- Infected stoma (the opening made in the belly)
- High blood sugar
- Higher than normal phosphate levels in the blood
- Inhaling the liquid formula into the lungs—aspiration
- A clogged or dislodged feeding tube
Gastroesophageal reflux disease may raise the risk of vomiting or aspiration.
What to Expect TOP
Prior to Procedure
If you are in the hospital or at a clinic, the staff will:
- Wash their hands before handling the supplies and the tube.
- Set up the supplies. This may include a syringe, measuring cup, feeding bag, electronic pump, and a pole to hang the bag.
- Use a formula that will provide the right amount of protein, fat, carbohydrates, vitamins, minerals, and fluid.
- Have you sit in an upright position.
- Check to make sure that the tube is in the right position before putting the formula in it. For example, if you have a gastrostomy tube, this may be done by using a syringe to extract a small amount of gastric fluids. Also, a ruler may be used to measure the length of the tube. If no gastric fluids are seen or if the length of the tube has changed, this may mean that the tube has become dislodged. More treatment will be needed.
- Use a syringe to flush the tube with water to prepare for the feeding.
Description of the Procedure
A nurse, trained caregiver, or family member may deliver the tube feeding. If the person is able, they may be taught how to give feedings on their own.
Feedings may be delivered by:
Syringe Method
The feeding tube will be clamped or kinked. A large syringe will be attached to it. The formula will be poured slowly into the syringe. The tube will then be unclamped, and the syringe will be held high. This allows gravity to move the formula through the tube. When the feeding is done, the tube will be flushed with water to prevent clogging. The tube will then be clamped again, and the syringe will be removed. The tube will be recapped and taped to the body. If the syringe method is used, you will need several feedings throughout the day. These are called bolus feedings.
Gravity-Drip Method
First, the formula will be poured into the feeding bag. The bag will be hung on a pole. The tube from the bag will be connected to the clamped feeding tube. When the two tubes are connected, the feeding tube will be unclamped, allowing the formula to flow. As with the syringe method, gravity will move the formula through the tube. The flow can also be adjusted using a regulator clamp. When the feeding is done, a syringe filled with water will be used to flush the tube. Lastly, the tube will be capped and taped to your body. You will have several feedings during the day.
Pump Method
These steps are similar to the gravity-drip method. The difference is that the tubes are connected to an electronic pump. The pump will be programmed to deliver the formula at a set rate per hour. For example, with continuous feeding, you will slowly be fed throughout the day. If you need this approach, the feeding will be stopped every 4 hours. The tube will be flushed with water so that it does not get clogged. The pump method can also be used for bolus feedings.
How Long Will It Take? TOP
- Syringe method: 15 to 20 minutes
- Gravity-drip method: 1 to 2 hours
- Pump method: varies depending on whether it is continuous feeding (8 to 12 hours) or bolus feeding
Will It Hurt? TOP
Getting nutrition through a tube is not painful. You may have an upset stomach. To lower the risk of this problem:
- Stay in an upright position during the feeding and for 30 to 60 minutes after the feeding.
- If advised by your care team, do not exercise after the feeding.
Postoperative Care TOP
After the tube feeding, the following steps will be taken by you or a caregiver:
- After thorough hand washing, the stoma site will be cleaned and gently dried.
- Feeding tube supplies will be cleaned with warm water and dish soap. The supplies will be rinsed and air-dried. For pumps, follow the manufacturer's guidelines.
Remember that you still need to take care of your mouth and teeth. Brush your teeth twice a day, or as advised by your care team.
Call Your Doctor TOP
If you have tube feeding at home, call your doctor right away if you have:
- Signs of infection, such as fever and chills
- Redness, swelling, pain, bleeding, or discharge at the stoma
- A clogged tube
- A dislodged tube—most common during the first 2 weeks
- Choking or problems breathing during the feeding
- Formula leaking around the tube
- Cough
- Chest pain
- Nausea and vomiting
- Belly swelling or pain
- Problems passing gas or stool
- Diarrhea
- Dry mouth
- Not been urinating as much or your urine is dark and smells bad
If you think you have an emergency, call for medical help right away.
RESOURCES:
Family Caregiver Alliance
https://www.caregiver.org
Family Doctor—American Academy of Family Physicians
https://familydoctor.org
CANADIAN RESOURCES:
Canadian Clinical Community
http://www.ccc-ccan.ca
Health Canada
https://www.canada.ca
REFERENCES:
Enteral feeding—an overview. Dietetics website. Available at: https://www.dietetics.co.uk/enteral-feeding.aspx. Accessed July 23, 2021.
Enteral nutrition support in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/enteral-nutrition-support-in-adults. Accessed July 23, 2021.
Gastrostomy feeding by syringe. Cincinnati Children’s website Available at: https://www.cincinnatichildrens.org/health/g/g-tube-syringe. Accessed July 23, 2021.
Tube feeding at home. Queensland Health Government website. Available at: https://www.health.qld.gov.au/__data/assets/pdf_file/0032/360896/etf_tfah.pdf. Accessed July 23, 2021.
Tube feeding systems. Oral Cancer Foundation website. Available at: https://oralcancerfoundation.org/nutrition/tube-feeding-systems. Accessed July 23, 2021.
Last reviewed July 2021 by
EBSCO Medical Review BoardDianne Scheinberg Rishikof MS, RD, LDN
Last Updated: 7/23/2021