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Feeding tubes are tubes inserted into the gastrointestinal tract to provide a patient with enteral nutrition or for decompression. Tubes come in a variety of sizes, lengths, and materials, depending on the longevity of the tube, placement method, and location. This activity outlines the different types of feeding tubes and reviews the role of the interprofessional team in evaluating and treating patients who undergo feeding tube insertions. Objectives: Identify the different types of feeding tube procedures and their particular indications. Describe the differences between the various feeding tube placement techniques. Summarize the potential complications of feeding tube placement. Outline interprofessional team strategies for improving care coordination and communication to advance the care of patients with feeding tubes and to improve their outcomes. Access free multiple choice questions on this topic.

Feeding tubes are tubes mainly inserted into the gastrointestinal (GI) tract to provide a patient with a route for enteral nutrition, though they can also be used for decompression of the GI tract. Tubes come in a variety of sizes, lengths, and materials, depending on the longevity of the tube, placement method, and location. When a patient is unable to intake any or adequate caloric nutrition by mouth, severe malnutrition may result, which will ultimately inhibit healing and contribute to critical illness. A feeding tube is an excellent option to provide the patient with enteral nutrition and can be accomplished in many ways.

Complications after percutaneously placed gastrostomy tubes include infection, tube migration, hemorrhage, stomal leak, ileus, and bowel injury.[8] Bowel injury is oftentimes hard to diagnose as a small amount of pneumoperitoneum after the procedure is to be expected. However, when compiled with pain and tenderness should be investigated further.[9] Another feared complications of percutaneous gastrostomy tubes is a transhepatic peg tube; usually, these are discovered incidentally on post-procedure imaging, but could also present with massive bleeding or sepsis. The use of ultrasound in patients with known hepatomegaly has been suggested to help avoid this complication.[10] When an open gastrostomy or open jejunostomy tube is placed, a rare but potential complication is a leak of gastric contents or tube feeds outside of the gastrostomy but into the abdominal cavity. This would likely be due to a technical error and can be prevented by testing the feeding tube with a saline flush while inspecting for leaks prior to abdominal closure. If a percutaneously placed feeding tube becomes dislodged prior to the stomach fusing to the anterior abdominal wall, the stomach will fall away, and the tube would then be intraperitoneal. Peritonitis and infection can occur. Emergent intervention is usually needed to either replace the gastrostomy tube or close the gastrostomy and place a new feeding tube. Both open and laparoscopic procedures aim to prevent this complication by securing the stomach or jejunum to the anterior abdominal wall.

It is important that all providers, including physicians, proceduralists, nurses, speech pathologists, and nutritionists, be well versed in this topic in order to provide the best care and outcomes possible for their patients. Speech pathologists are usually recommending feeding tube placement after a thorough evaluation of the patient's ability to safely swallow. A surgeon or proceduralist (including endoscopist and an interventional radiology physician) is responsible for performing that patient best suited for that patient. The nurses play a vital role as a member of the interprofessional group as they will monitor the patient before and after the procedure, as well as administer medication and nutrition through the feeding tube as well as provide daily maintenance as needed for the feeding tube. The nutritionist will calculate the number of calories and macronutrients that the patient is in need of and will recommend the type of tube feedings and the rate. Understanding this topic has the ability to impact many patient’s lives due to its clinical significance and the importance of ensuring each patient is able to receive nutrition, hydration, and medication.