Tube feeding

About tube feeding

Tube feeding is a way of giving the body the nutrition it needs when a person can no longer eat and drink enough or safely.

A tube allows a liquid or specialised ‘feed’ to enter the stomach or small intestine.

Nasogastric tube feed graphic showing tube and position in stomach

Different types of tube feeding

A healthcare professional will recommend the type of feeding tube that is best. Here are some examples…

peg tube feed example 1

How to manage tube feeding

Training is always provided when a tube is placed, if you think you need further training then please let your health team know.

The dietitian will recommend a method of pump or bolus feeding.

  • Pump feeding means the feed is controlled through a pump and given over several hours throughout the day.
  • Bolus means the feed is given through a syringe which can be slowly dripped into the tube via gravity or pushed through with the syringe plunger.

The dietitian will design a feeding plan that gives all the nutrition and hydration that is needed for the individual and that fits into a person’s lifestyle.

The feeding plan will have all the details that you need to follow. Including amount of feed and water, rate of feed and anything extra to the individual.

Tube Care

Before using, please check the tube is free from breaks.

Regular tube changes, depending on the type of tube, are very important.

Make sure the site of the tube (around the nose or close to the abdominal skin) is kept dry, clean, and wound-free.

Some tubes have a fixator. The fixator needs to be about a finger width away from the skin. The video below helps to understand the opening and positioning of the fixator.

If the fixator is too close to the skin this can cause a sore or red mark. It can easily be moved slightly further away from the skin. The fixator may be too far away from the skin which can cause leaking from the site.

Sometimes a wound around the tube remains sore and red, this is known as over granulation. This needs to be treated, please contact the dietitian or nurse.

It is rare but the tube may become blocked. This can be prevented by flushing the tube regularly as per the plan, before and after a feed and medications.

Here are a few tips to unblock the tube

  • Try to massage the tube with your finger and thumb, you may be able to see the blockage and dislodge it this way
  • Try a small amount of carbonated water to see if the bubbles help flush the blockage
  • Please do not try to force water or feed down the tube if you feel there is a blockage or an error message on the pump. If you are unable to unblock the tube, you should seek immediate advice from the nurse or dietitian
  • Some tubes need daily advancing and rotation to ensure hole remains open
  • Please make sure you have spare equipment such as a tube or enplug in case the tube comes out.

Troubleshooting

Tube feeding can cause some persistent symptoms such as:

Bloating, diarrhoea, constipation, excess gas and reflux.

graphic showing impacted bowels
graphic depicting acid reflux

Some of these symptoms can be resolved by a carer.

Bowel medication can be reviewed a GP.

graphic of doctor with speech bubble with medicines to show 'giving medicine advice'

People can feel full quickly or bloated during or after feeds and this can be uncomfortable, cause burping, gipping or vomiting. It is important to make sure there is no extra air entering the tube and you are following guidance on prepping the tube.

Venting is a method of releasing air from your stomach and bowels through the feeding tube. Venting before a feed allows air to escape the stomach before it is filled and helps to prevent fullness and bloating.

You can vent by attaching an open syringe, without the plunger, to the tube port and allowing air to release through the syringe. About 30 minutes before a feed starts or medication.

Please stop venting if any stomach contents enter the syringe and do vent directly after a feed.

It is not safe to feed while lying flat. It can cause acid reflux and aspiration which can lead to chest infections.

The best position when tube feeding is to be sat upright. If this is not possible you should be propped up to an angle of at least 45 degrees. You should remain in this position for 60 minutes after the feed has finished. This will help food to settle in your stomach and help to prevent complications.

Please see posture video for more detail.

It is important to care for the mouth when tube feeding to prevent infections and tooth decay. People who are tube-fed are more likely to have a build-up of tartar which can be difficult to remove. The bacteria in plaque can cause chest infections.

Aim to clean the teeth and mouth at least twice a day even if they are not eating or drinking.

Hydration is important in preventing constipation, reflux and tube blockages.

Following the feeding plan will maintain hydration, but there are also times where a person needs more fluid. For example, when the weather is hotter or when they are unwell.

Signs of dehydration may be a dry mouth, dry or broken skin, poor wound healing, constipation, changes in mood and less frequent urination. You may try to give extra flushes spread throughout the day unless the person is on fluid restriction.

If symptoms persist after trying some of these changes please contact the dietitian. They will review your feed plan, check volume, rate and type of feed.

Any changes to weight, gain or loss, please contact the nurse or dietitian for advice.