Tube Feeding 101: Getting started with a tube feeding dietitian

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You’re having difficulty eating what you need, you are losing weight, you have no energy, and you’re getting weaker. Your family and friends are worried about you and someone even suggested you look into finding a tube feeding dietitian and consider a feeding tube.

I’m Jen, a tube feeding dietitian, and I’ve helped countless people just like you start on tube feeds, learn how to feed themselves and thrive at home on tube feeds. You can thrive too!

Right now a feeding tube terrifies you and you don’t want to give up on eating but you can’t carry on like this either. 

It doesn’t need to be terrifying and I’m going to talk you through the basics to get started. 

Having some basic knowledge about the different types of tubes, methods of feeding and formulas available can help you feel more confident talking to your healthcare team about your options.

You will feel empowered to make informed decisions about your feeding along with your healthcare team so you can start to feel better, get stronger and stay nourished.

What is tube feeding?

Tube feeding, also called enteral feeding, may be used when you can’t eat by mouth at all or if you can’t eat enough by mouth to get what your body needs.

Difficulty swallowing or poor eating may be related to an illness or medical condition.

A tube is used to give you liquid food and fluids. 

A tube feeding dietitian is a dietitian specializing in tube feeds. They will help determine your specific nutrition needs and come up with a nutrition plan that works for your specific situation.

There are several different types of feeding tubes and the appropriate tube for you will depend on your medical condition or illness, and how long you’re expected to need tube feeding.

Different types of feeding tubes

There are several different types of feeding tubes, and they are named based on where they are placed (1).

– “Naso” refers to the nose

– “Gastro” refers to the stomach

– “Jeju” refers to the jejunum, which is a part of the small intestine.

Nasogastric tube

A tube that is inserted through your nose, travels down through your esophagus (a.k.a. food tube) and ends in your stomach is called a nasogastric tube or NG tube (2).

Nasojejunostomy tube

A tube that is inserted into your nose, passes through your esophagus and your stomach and ends in your jejunum is called a nasojejunostomy or NJ tube. 

Tubes inserted through the nose are generally meant for you if you need tube feeds for less than 6 weeks (3). 

Gastrostomy tube

PEG tubes or G-tubes are tubes inserted directly into the stomach. The “G” refers to gastro or stomach (1). 

The tube is inserted through an incision in your abdomen and into your stomach. A disc or balloon on the inside of your stomach acts as an anchor for the tube so it will not fall out (4)

Gastrojejunostomy tube

A gastrojejunostomy or GJ tube is inserted through your abdomen, and into your stomach the same way as the PEG tube but it will be longer on the inside and end in your jejunum. 

Jejunostomy tube

A jejunostomy or J-tube goes directly into your jejunum. It is inserted through an incision in your abdomen and ends in your jejunum (1). 

From the outside, it will look similar to the PEG tube but is lower on your abdomen. 

Tubes that are inserted directly through your abdomen are usually used if your healthcare team expects that you’ll require tube feeding longer than a few weeks.

You can ask your healthcare team what type of tube may be right for your particular situation. Your choices will be guided by your medical situation and your needs.

Next, we’ll consider what to feed you through your tube.

Tube feeding formula

Once you have your feeding tube inserted, your healthcare team and tube feeding dietitian will talk to you about starting your tube feeding formula (also called enteral formula).

Not to worry – you can live a long, healthy life on formula alone if you can’t eat at all.

If you can still eat by mouth then you can have a combination of tube feeding and eating by mouth. It doesn’t have to be all or nothing.

You don’t have to use all one type of formula. Your feeding plan can be individualized to suit your needs.

There are several options when it comes to tube feeding formulas. There are commercial synthetic formulas, commercial blenderized food formulas and you can also blend your own food for your tube feeding.

The formula goes into your stomach or intestine (depending on your type of tube), and gets digested like food does, giving your body energy and nourishment.

Formulas contain macronutrients (carbohydrate, fat, protein) as well as vitamins and minerals that your body needs to survive, and even thrive!

Commercial formulas

Commercial synthetic formulas and commercial blenderized formulas usually come in a can or tetra pack (like a drinking box) that is put through your tube (more on different feeding methods shortly).

Often you would be started on commercial formulas in the hospital because they are standardized, shelf stable and provide you with specific nutrients for your individual needs, or medical condition. 

Commercial synthetic formulas can be made for specific medical needs. For example, a formula may have a lower amount of carbohydrates or sugar for those with diabetes. 

Similarly, a formula with low potassium, phosphorus and sodium is made for people with kidney disease. 

Your healthcare team knows exactly how much nutrition you are getting because there is a known amount of nutrients in each can or container of formula.

Since food based formulas have become more popular and in demand, formula companies have also started to produce commercial blenderized food based formulas as well.

Blenderized tube feeding

Maybe making your own blenderized tube feeds interests you. Blenderized tube feeds may be an option for you when you are medically stable and heading home on tube feeds.

Blenderizing your own food may appeal to you if you love to cook, want an increased variety of foods in your diet or you don’t tolerate the canned formulas well. 

If blenderizing your own food for your tube feeds sounds like something you want to try, check out my blog post on blenderized tube feeds to see if it may be right for you.

You should always consult with your doctor or tube feeding dietitian before changing your feeding regimen.

The next part of your feeding plan involves what method you will use to feed yourself.

Methods of feeding

There are several different ways to feed yourself. The appropriate method for you will depend on your type of tube, your tube feed formula, your tolerance to tube feeding and your lifestyle and schedule.

You aren’t stuck with one method once you start. In fact, once you start, you should follow up with your team to report how you are tolerating your feed and how your feeding schedule can be adjusted (if needed).

Syringe feeding

This method uses a large syringe (not the kind with a needle) that connects to your feeding tube, whichever type you have.

Your formula or blended tube feeding is drawn up into the syringe, then connected to your feeding tube and then pushed into your tube with the syringe. This method delivers your nutrition quickly into either the stomach or intestine

This method is a great option if you have a tube in your stomach. It can be given quickly and you are not attached to something for long so you can continue your other daily activities.

Often this method isn’t one that you would start with if you have a jejunostomy tube due to possible cramping, bloating and diarrhea. However, you may be able to tolerate this faster infusion (5). 

If you have a J-tube and you want to pursue this method, you should talk to your healthcare team to see if it could work for you.

Gravity feeding

This method uses a bag, connected to a tube, which then connects to the tube coming from your body. Formula or blended food is poured into the bag and hung above your feeding tube. The formula or food flows by gravity through the tube and into your body. 

This method delivers nutrition a little slower than the syringe method of feeding but you can’t regulate exactly how slow or fast it flows.

With gravity feeding, you would be connected to your feed for short periods of time during the day, similar to sitting down for a meal with the family. 

Pump feeding

Pump feeding uses a bag and tube similar to gravity feeding but the bag and tubing are connected to a pump. 

The pump helps push the formula through the tube and into your body at a regulated speed.

This method is often used if you need the feed to run slower, over a longer period of time. It can be run continuously or at certain times of the day.

Speak to your healthcare team about how you want your feeds to work with your lifestyle or family schedule. 

Your feeding plan does not have to be set in stone, so it’s important to communicate with your healthcare team about how you are tolerating the feeding plan and how it’s working (or not working) for you.

Finding what works for you

If you can, speak to your healthcare team, and tube feeding dietitian before you get your tube to discuss your options.

The reason for your feeding tube and how long you need it for will help determine where your tube is going to be placed.

The formula and method of feeding available to you will also depend on where the tube is located and how you tolerate tube feeding. 

Talk to your healthcare team about what feeding schedules may work for you and your needs. 

If you need to go home on tube feeding, ask about what supplies and equipment will be provided and what you need to obtain on your own. Depending on where you live, there may be funding available to cover some of these costs.

Seek ongoing follow up to monitor how things are going and adjust your treatment plan as needed. 

While at first tube feeding may seem intimidating, with the right information and regular communication with your healthcare team, it is possible to be successful with tube feeding and even thrive!

If you are new to tube feeding (or maybe not so new) and you want some more support with your tube feeding, contact me here and let’s chat about how I can help you become the expert with your tube feeds.

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