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Feeding tube
Feeding tube
Intervention
A malnourished child with a feeding tube. ICD-9-CM MeSH 96.35 [1] [2]
D004750
A feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by swallowing. The state of being fed by a feeding tube is called gavage, enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. A variety of feeding tubes are used in medical practice. They are usually made of polyurethane or silicone. The diameter of a feeding tube is measured in French units (each French unit equals 0.33 millimeters). They are classified by site of insertion and intended use.
Feeding tube stomach either by a balloon on its tip (which can be deflated) or by a retention dome which is wider than the tract of the tube. Gastric feeding tubes are suitable for long-term use, though they sometimes need to be replaced if used long term. The G-tube can be useful where there is difficulty with swallowing because of neurologic or anatomic disorders (stroke, esophageal atresia, tracheoesophageal fistula), and to avoid the risk of aspiration pneumonia. However, in patients with advanced dementia or adult failure to thrive it does not decrease the risk of pneumonia.
Effectiveness
The effectiveness of feeding tubes varies greatly depending on what condition they are used to treat.
ICU
Nasogastric tubes are often used in the intensive care unit to provide nutrition to critically ill patients while their medical conditions are addressed. There is moderate evidence for use of feeding tubes in the ICU, especially if requiring mechanical ventilation for more than three days.
Advanced Cancer
There is no evidence that feeding tubes are beneficial in any way for patients who are losing weight with advanced cancer that is not directly related to problems swallowing due to the cancer, such as cancers of the throat or esophagus. Feedings tubes are frequently used in these populations, but studies to date have yet to prove that they are helpful.
Feeding tube The most frequent complication is irritation around the site of the insertion, generally caused by stomach acid and feedings leaking around the site. Barrier creams, dressings, and frequent cleaning is generally recommended. Especially in advanced dementia, patients can pull at the feeding tubes causing them to be dislodged and requiring a hospitalization to replace them. Feeding tubes may become clogged or occluded if not flushed with water after each feeding. A clogged tube may need to be replaced.
Withdrawal
Tube feeding, like all medical treatments, can be declined or stopped, especially in the setting of a terminal illness where its use would not alter the ultimate outcome. Alternatively, nutrition can be withheld and the tube used only for hydration and medicine if desired. Some patients or families will opt for a "time limited trial" of feeding through a tube, but after a set time period if the individial is not improving feedings are stopped and the goals of care are refocused to comfort measures.
External links
Pediatric Feeding Tube [8] Oral Cancer Foundation [9] The Oley Foundation Provides free information and peer support for people on home tube and IV feeding [10]
References
[1] http:/ / icd9cm. chrisendres. com/ index. php?srchtype=procs& srchtext=96. 35& Submit=Search& action=search [2] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi?field=uid& term=D004750 [3] http:/ / jama. ama-assn. org/ content/ 282/ 14/ 1365. short [4] http:/ / archinte. ama-assn. org/ cgi/ content/ abstract/ 157/ 3/ 327 [5] http:/ / archinte. ama-assn. org/ cgi/ content/ abstract/ 161/ 4/ 594 [6] http:/ / www. drplace. com/ Feeding_Tubes_in_Patients_with_Severe_Dementia. 16. 28273. htm [7] Peck A, Cohen CE, Mulvihill MN. Long-term enteral feeding of aged demented nursing home patients. J Am Geriatr Soc. 1990;38:11958 [8] http:/ / www. pediatricfeeding. org/ tube_feeding. html [9] http:/ / www. oralcancerfoundation. org/ dental/ tube_feeding. htm [10] http:/ / www. oley. org
License
Creative Commons Attribution-Share Alike 3.0 Unported http:/ / creativecommons. org/ licenses/ by-sa/ 3. 0/