Overview of Feeding Tube
Feeding tubes are special kinds of tubes put into the stomach and intestines. They help people who can’t eat by mouth to get the nutrition they need. These tubes can also be used to relieve pressure in the stomach and intestines. These tubes come in different sizes, lengths, and materials based on how long they will be used, how they are inserted, and where they are placed. If a person can’t eat enough through their mouth, they could become very malnourished. This can slow down healing and contribute to serious illnesses. In these situations, a feeding tube can be a great solution to make sure the person gets the nutrition they need. There are many ways to accomplish this.
Anatomy and Physiology of Feeding Tube
Before a feeding tube is placed into your stomach through a cut or puncture, it’s crucial for the doctor to understand the layout of your stomach and the areas around it. Your stomach is made up of several different sections. The gastroesophageal junction is where the food pipe (esophagus) connects to the stomach. The fundus is the upper part of the stomach, closest to the diaphragm, which is a muscle that helps us breathe. The pylorus is a door-like valve that connects the stomach to the duodenum, which is the first part of the small intestine. Beside to the pylorus is an area called the antrum, and the remaining part of the stomach is just referred to as “the body”. The ideal place for a feeding tube is in the front part of this “body” section of the stomach.
On the large curve of the stomach is an apron-like structure, known as the greater omentum, that forms a ligament called the gastrocolic ligament, which connects to part of the large intestine called the transverse colon. The doctor must consider how close these structures are during the placement of a percutaneous (through the skin) feeding tube in your stomach.
It’s also essential to take into account any individual variations in this anatomy. For example, if a person has an enlarged liver (hepatomegaly), the left section of the liver may cross over the center of the body. While images of the area aren’t necessarily needed before placing a feeding tube, if such images are available, it is recommended for the doctor to review them beforehand. Additionally, the doctor should be aware of your past surgeries and examine your abdomen thoroughly before the procedure.
Why do People Need Feeding Tube
When a person has trouble eating normally, they might need a feeding tube to help them get the nutrients they need. The type of feeding tube used depends on how long the person needs help with eating.
If the help is needed for only a short time or it’s not sure how long it will be needed, a temporary feeding tube may be used. This is common in situations where a person cannot swallow because they need a machine to help them breathe. The tube is thin and flexible, and it is usually inserted through the mouth or nose and ends in the stomach or small intestine. To make sure the tube is in the right place, a simple x-ray is often done.
If the person is expected to need help with eating for more than 30 days, a different type of feeding tube, called a gastrostomy tube, can be used. This is often the case when someone has severe trouble swallowing or is very malnourished. Sometimes, this tube is also used to help keep the stomach in place after a specific type of stomach surgery. These tubes are a little wider, but shorter than the temporary tubes, and are also made of a flexible material since they are meant to stay in place for a longer time.
There is also a type of feeding tube called a gastrojejunal tube. This has two channels, one ending in the stomach and one ending in the small intestine. It’s often used when a person needs to relieve pressure in their stomach while getting nutrients through the channel that ends in their small intestine. It’s usually placed with special X-ray guidance, but it can also be placed using a special lighted tube if needed.
Feeding tubes that go past the stomach into the small intestine are also used when a person’s internal body structure has been changed due to surgeries like the Billroth II or Whipple procedures, if there’s a blockage keeping food from leaving the stomach, or from severe pancreatitis, and other conditions.
When a Person Should Avoid Feeding Tube
If a patient or their family is not willing to give permission for the surgery, the doctors cannot carry it out. This rule always applies, especially with non-emergency, or “elective”, procedures. Other reasons that doctors might decide not to proceed with an elective procedure include if the patient is severely ill and their body isn’t stable, if they have an infection throughout their body known as sepsis, if they have a serious blood clotting problem that cannot be fixed, if they have severe fluid build-up in their abdomen (ascites), if there is an infection in the stomach wall where the surgery is planned, or if they have a type of cancer that has spread throughout the lining of the abdomen (peritoneal carcinomatosis).
For patients with certain conditions like a blockage at the exit of the stomach (gastric outlet obstruction), delayed emptying of the stomach (severe gastroparesis), or changes in their stomach anatomy from previous surgeries (such as Roux-en-Y surgery or stomach removal), the doctors should think about different ways to deliver food into the gut. This is because a direct route into the stomach (gastrostomy) might not be suitable for these patients.
Preparing for Feeding Tube
Feeding tubes are often inserted as a planned procedure. In few cases, a surgeon may decide to insert a feeding tube during an emergency procedure if they think the patient will need tube feeding for a long time. However, this is not common. Before the procedure, the patient should be in the best possible health. If possible, blood-thinning medication, or ‘anticoagulation’, should be paused. A specialist in anaesthetics must check and assess the patient’s condition before the procedure. This check-up can be done in advance since the patient is already in the hospital. This allows any potential issues to be resolved before the procedure. The patient should not eat or drink anything (NPO – nil per os) after midnight before the procedure. If the patient is getting nutrition through a feeding tube in the nose or mouth, these feedings should also be stopped.
How is Feeding Tube performed
There are a few methods used to place a feeding tube, depending on the patient’s needs.
Open Stamm Gastrostomy involves making a cut above the belly button. The front of the stomach is then visible. A spot on the stomach that allows it to be moved towards the front of the stomach without strain is selected. A thin tube is then placed through the cut, into the stomach.
Open Witzel Jejunostomy is when a feeding tube is placed in a different part of your intestines, called the jejunum. The tube is passed through a cut in your belly and secured with stitches.
Laparoscopic Feeding Tube Placement is similar, but uses a camera to guide the surgeon. Small cuts are made in your belly, and the stomach or part of the intestines is moved up towards the skin. A small hole is cut into the stomach or intestines and a feeding tube is put in, then sutured tight.
Percutaneous Gastrostomy Tube method places a feeding tube through a small hole in your skin, into your stomach. This may be done using X-rays or a type of telescope called an endoscope to guide the doctor.
The Endoscopic Percutaneous Gastrostomy Tube Placement uses a similar method but includes a scope going down through the mouth, into the stomach. A spot is chosen for tube insertion and a small cut is made on the skin. The feeding tube is attached to a wire and pulled from the mouth and out of the belly.
Percutaneous Radiographic Gastrostomy Tube approach is slightly different. A tube is passed down the nose and the stomach is filled with air. The stomach is identified using X-ray, and a needle is passed through your skin into your stomach. The feeding tube is inserted using the same cut.
The type of procedure used may vary depending on the facilities available and the specific needs of the patient.
Possible Complications of Feeding Tube
After placement of a gastrostomy tube (a feeding tube placed through the abdomen into the stomach) through a minimally invasive procedure, a few issues might arise. These issues can include infection, the tube moving from its original position, bleeding, leakage around the tube, intestinal obstruction, or injury to the bowel. It can be hard to identify a bowel injury because a small amount of air escape into the abdomen is normal after the procedure. However, if this comes with pain and tenderness, it should be further examined.
One specific issue to look out for is a gastrostomy tube going through the liver, which can lead to severe bleeding or severe infection. It is usually found unexpectedly during scans after the procedure. This is especially worrying if your liver is enlarged; for these patients, ultrasound has been suggested to assist and prevent this issue from happening.
Another possible and rare complication occurs when an open gastrostomy or open jejunostomy (feeding tube placed into the small intestine) is placed. This issue involves the leaking of stomach contents or feeds from the tube into the space within the abdomen, which doesn’t usually happen. This complication can be prevented by checking for leaks – typically done by flushing saline through the feeding tube and looking for leaks before the abdomen is surgically closed.
If the feeding tube gets displaced before the stomach attaches to the anterior abdominal wall (the front of the abdomen), the stomach falls back, leaving the tube inside the abdomen. This can result in peritonitis (inflammation of the lining of the abdomen), which can then cause infection. In this case, a quick intervention is necessary to either reposition the gastrostomy tube or close the gastrostomy and place a new feeding tube. Both open and laparoscopic (minimally invasive surgery) procedures aim to prevent this complication by attaching the stomach or the jejunum to the anterior abdominal wall.
What Else Should I Know About Feeding Tube?
Feeding tubes come in different types and can be inserted into the body using different methods – some more invasive than others. This is an essential topic that medical professionals need to understand, so they can choose the best procedure for each patient.