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Tube Feeding – Definition, Types and Application

Tube feeding is a medically formulated liquid nutrition delivered directly into the gastrointestinal tract via a feeding tube when normal oral food intake is not possible or sufficient.

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Things worth knowing about "Tube Feeding"

Tube feeding is a medically formulated liquid nutrition delivered directly into the gastrointestinal tract via a feeding tube when normal oral food intake is not possible or sufficient.

What is Tube Feeding?

Tube feeding, also known as enteral nutrition, is a method of delivering nutritionally complete liquid formulas directly into the stomach or small intestine through a feeding tube. It is used when patients are unable to consume adequate nutrition orally due to illness, injury, or medical conditions. All essential nutrients -- including carbohydrates, proteins, fats, vitamins, minerals, and trace elements -- are provided in precisely calculated amounts.

Indications

Tube feeding is indicated in a wide range of clinical situations where oral intake is insufficient or unsafe:

Swallowing disorders (dysphagia) following stroke or in neurological diseases
Severe gastrointestinal conditions (e.g., Crohn's disease, short bowel syndrome)
Cancers affecting the mouth, throat, or esophagus
Unconsciousness or intensive care treatment
Severe malnutrition or anorexia nervosa
Premature infants and critically ill newborns

Types of Tube Feeding Formulas

Standard Formulas

Standard enteral formulas are nutritionally complete and designed to meet the full daily requirements of an adult. They provide a balanced mix of macronutrients and micronutrients suitable for patients without specific metabolic conditions.

Specialty Formulas

Disease-specific formulas are available for patients with particular medical needs:

Diabetes formulas: reduced carbohydrate content with a lower glycemic profile
Renal formulas: reduced protein, potassium, and phosphate for patients with kidney disease
Hepatic formulas: enriched with branched-chain amino acids for patients with liver disease
Pulmonary formulas: higher fat and lower carbohydrate content to reduce carbon dioxide production
Immune-modulating formulas: supplemented with arginine, omega-3 fatty acids, and antioxidants
Pediatric formulas: specifically developed for infants and children

Routes of Administration

Nasogastric Tube (NGT)

A nasogastric tube is passed through the nose into the stomach. It is the most commonly used route for short-term enteral nutrition, typically up to four weeks.

Nasojejunal Tube

This tube is advanced through the nose past the stomach and into the small intestine (jejunum). It is used when gastric emptying is impaired or when there is a risk of aspiration.

Percutaneous Endoscopic Gastrostomy (PEG)

A PEG is a tube placed endoscopically through the abdominal wall directly into the stomach. It is preferred for long-term enteral nutrition (more than four weeks) and is generally more comfortable for the patient.

Percutaneous Endoscopic Jejunostomy (PEJ)

Similar to a PEG, but the tube is extended further into the small intestine. It is used when the stomach needs to be bypassed entirely.

Delivery Methods

Tube feeding can be administered in several ways depending on the clinical situation:

Continuous infusion: delivered around the clock or over many hours via a feeding pump
Intermittent feeding: given in several portions throughout the day, mimicking normal meal patterns
Bolus feeding: larger volumes delivered rapidly, usually via a syringe

Nutritional Composition

Commercially manufactured tube feeding formulas are designed to provide all essential nutrients. A typical standard formula delivers:

Energy: typically 1.0 to 1.5 kcal per milliliter
Protein: approximately 15 to 20% of total energy
Carbohydrates: approximately 45 to 55% of total energy
Fat: approximately 30 to 35% of total energy
Dietary fiber: included in fiber-enriched variants
Vitamins and minerals: in accordance with current international reference values

Possible Complications

Enteral nutrition via feeding tube is generally well tolerated but may be associated with certain complications:

Gastrointestinal symptoms: nausea, vomiting, bloating, diarrhea, or constipation
Aspiration: entry of formula into the airways, especially in patients with impaired protective reflexes
Tube occlusion: caused by insufficient flushing of the tube
Local infections: at the insertion site of PEG or PEJ tubes
Refeeding syndrome: dangerous electrolyte shifts during rapid refeeding of severely malnourished patients

Home Enteral Nutrition

Many patients who require long-term tube feeding can receive it at home. Home enteral nutrition allows individuals with persistent swallowing or chewing difficulties to remain in their familiar environment. Patients, caregivers, and family members receive appropriate training. In medically indicated cases, costs are typically covered by health insurance providers.

References

Lochs H., Allison S.P., Meier R. et al. - Introductory to the ESPEN Guidelines on Enteral Nutrition. Clinical Nutrition, 2006; 25(2): 180-186.
Weimann A., Braga M., Carli F. et al. - ESPEN guideline: Clinical nutrition in surgery. Clinical Nutrition, 2017; 36(3): 623-650.
World Health Organization (WHO) - Nutritional support for patients with COVID-19 and other conditions: interim guidance. WHO, 2020.

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