Feeding tubes are used to provide liquid nutrition to individuals who accept difficulty chewing and/or swallowing or who are completely unable to eat on their own. The conclusion to use a feeding tube is often a complex one, specially for older patients. Family unit caregivers may find themselves responsible for making this difficult choice on an aging loved one's behalf someday, so information technology is important to understand why and when tube feeding is appropriate. Unfortunately, the data that medical professionals provide on this topic is not always very articulate or accurate.

Types of Feeding Tubes

There are several kinds of feeding tubes that are used for different reasons and for different lengths of time. The proper name of each type of feeding tube typically describes its insertion indicate and/or ending betoken in the body.

Non-Surgically Inserted Feeding Tubes

Temporary feeding tubes are introduced via the nose (nasal) or mouth (oral). Depending on where diet, fluids and/or medication must be delivered in the body, the tube may end in the tummy (gastric) or one of two areas of the modest intestine chosen the duodenum (duodenal) or the jejunum (jejunal). For example, a nasogastric tube (NG tube) is inserted via the nose and ends in the stomach, while an orogastric tube (OG tube) is inserted via the mouth and ends in the tum.

Non-surgically inserted feeding tubes are typically used for curt-term tube feedings while a person heals and their ability to eat safely improves. Their employ for longer than a couple of weeks can cause severe irritation and injury to the tissues of the olfactory organ, throat and esophagus.

Surgically Inserted Feeding Tubes

Percutaneous feeding tubes are surgically inserted via an incision in the abdominal wall chosen a stoma or ostomy. These more invasive tubes are typically placed for long-term or permanent utilise, but they can be removed if a patient regains the power to swallow and drink on their own. Like nasal and oral tubes, percutaneous tubes may end in the stomach (known as a gastrostomy tube or G-tube) or in the small intestine (known as a jejunostomy tube or J-tube).

Why Are Feeding Tubes Used?

There are many reasons why people of all ages may require a feeding tube either temporarily or permanently. Certain head, neck and esophageal cancers tin can forbid patients from eating normally, as can head trauma, traumatic brain injury (TBI), stroke, and neurological disorders like dementia and Parkinson'southward disease. Feeding tubes may also be recommended for individuals who reject to eat and have become malnourished.

Family unit members of seniors who have advanced Alzheimer's illness or related dementias are often urged to consider feeding tube placement. This is usually considering tardily-phase dementia patients develop a condition called dysphagia, where they lose the power to chew and swallow safely. In addition to ensuing undernutrition, dysphagia increases a patient'due south risk of inhaling food or beverage and developing aspiration pneumonia, a serious lung infection that can be fatal.

In other cases, a feeding tube may exist required if a person has been placed on a ventilator to help them breathe. Utilize of a ventilator oftentimes requires a surgical procedure called a tracheostomy to create a surgical airway in the trachea. A tube called a trach tube is placed in this opening to clear secretions in the lungs, but the trach tube also prevents a patient from taking food and drink by mouth.

The Controversy Over Bogus Diet and Hydration at the Cease of Life

For many seniors who are not conscious or mentally capable of making their ain health care decisions, the choice to use a feeding tube typically falls to their amanuensis under a medical power of attorney or legal guardian. The thought of a loved one no longer eating or drinking is agonizing for virtually people to consider, specially considering it is their responsibleness to make the best possible intendance decisions and minimize discomfort. Even so, the placement of a feeding tube is not a simple fix that is free of complications or risks.

A type of abdominal tube called a percutaneous endoscopic gastrostomy or PEG tube (named for the procedure used to identify it) is commonly what medical professionals recommend, peculiarly for patients with late-stage dementia who tin no longer eat or turn down to practice and so. Placement of the tube is not particularly difficult or risky, but complications may arise from the incision and its ongoing use.

PEG tubes are meant to prevent aspiration, minimize the risk of pneumonia, increase nutritional intake and assist fortify the immune system to promote healing and functionality, but research has failed to evidence that such aggressive intervention delivers these benefits. Infection and leaking of the surgical site are concerns, and aspiration is however a possibility. Furthermore, a patient may need to be physically or chemically restrained to prevent them from forcibly pulling out their feeding tube.

Disinterest in or refusal of nutrient and drink are common symptoms at the terminate of life, regardless of what health weather condition are present. This is a natural footstep in the progression towards death as the body begins to shut down normal processes similar digestion. In fact, consumption of food and fluids may even crusade discomfort for some final patients.

The all-time alternative to tube feeding for seniors with severe dementia is careful manus feeding. In a position statement, the Alzheimer'southward Clan emphasizes that "conscientious hand feeing offers the highest quality of care and should be offered to all individuals with advanced Alzheimer'due south disease who tin competently and comfortably handle oral feeding."

During this process, trained aides will offer nutrient that is typically pureed and/or thickened and read a patient's verbal and nonverbal cues to determine whether they are hungry, thirsty or experiencing any discomfort. Hand fed patients are advisedly observed to prevent aspiration and are non forced to eat or drink if they practice non evidence any interest in the procedure. Family members can also participate in mitt feeding, which adds a valuable social component to meal times.

Unlike tube feeding, hand feeding is a time-consuming process that requires full 1-on-ane supervision. Doctors at skilled nursing facilities and hospitals may overstate the benefits of feeding tube placement considering this selection is easier and faster for staff members to handle.

The Decision to Place a Feeding Tube

Feeding tubes of all kinds certainly serve an important purpose, primarily for individuals who are non in the belatedly stages of an untreatable affliction. Unfortunately, tube feeding is not benign for all patients who cannot swallow or who turn down to eat, merely this intervention should be considered on a case past case basis. In a position statement, the American Academy of Hospice and Palliative Medicine recommends that "[bogus nutrition and hydration] should exist evaluated by weighing its benefits and burdens in low-cal of the patient's clinical circumstances and goals of care."

This is just one important end-of-life issue that many seniors and family caregivers face. It is crucial for families to discuss preferences for end-of-life intendance and put them in writing early to avoid confusion and ensure one some other's wishes are respected. Living wills and advance directives, such as do-not-resuscitate (DNR) orders and physician orders for life sustaining treatment (POLST) forms, are vital for recording finish-of-life care choices and should include if, when and for how long an individual wants to be fed in this mode.

Ultimately, choosing whether to elect tube feeding for oneself or equally an advocate for someone else is not an piece of cake task. Thoroughly discussing the pros and cons of feeding tubes—every bit well as alternatives—takes time and effort for medical professionals and families, but it is well worth the investment. Working closely with a loved 1'south health intendance squad is the best mode to gain a complete agreement of the difficult ethical principles and medical options at hand.