Enteral (tube) feeding: routes, feeds, indications and complications
Enteral feeding gives liquid food through the gut, by mouth or tube. The rule: if the gut works, use it.
What enteral feeding is
Enteral nutrition means feeding into the gastrointestinal tract. It includes oral supplements, but in exams it usually means tube feeding. It is used when the gut works but the patient cannot, will not or should not eat enough by mouth. It is preferred over parenteral feeding because it keeps the gut lining healthy, has fewer infections, is cheaper and is more physiological.
Routes of tube feeding
| Route | How the tube goes | Best for |
|---|---|---|
| Nasogastric (NG) | Nose → oesophagus → stomach | Short-term feeding (about 4-6 weeks or less) when the stomach empties normally |
| Nasoduodenal or nasojejunal | Nose → past the stomach into the duodenum or jejunum | Short-term feeding with high risk of aspiration or poor stomach emptying |
| Gastrostomy (PEG) | Through the abdominal wall into the stomach, placed by endoscopy or surgery | Long-term feeding: stroke, head and neck cancer, motor neurone disease |
| Jejunostomy | Through the abdominal wall into the jejunum | Long-term feeding when the stomach cannot be used, or after upper GI surgery |
Types of feeds and methods of giving them
| Type | What it is | Example of use |
|---|---|---|
| Blenderized (kitchen) feed | Milk, egg, rice or ragi flour, dal, sugar, oil and vegetable soup blended and strained | Common in Indian hospitals; low cost; needs strict hygiene |
| Polymeric (standard) formula | Whole protein, starch and fat; usually about 1 kcal per mL | Most patients with normal digestion |
| Peptide-based or elemental formula | Pre-digested: peptides or amino acids, simple sugars, little fat | Poor digestion or absorption: pancreatitis, short bowel |
| Disease-specific formula | Changed for one disease | Diabetic (low GI), renal (low electrolytes), high-protein for burns |
| Modular feed | Single nutrient added to another feed | Protein powder, glucose polymer, MCT oil |
| Bolus method | 200-400 mL by syringe or gravity over a few minutes, several times a day | Stable patients with NG or PEG tube |
| Intermittent method | A feed run over 30-60 minutes every few hours | Patients who do not tolerate bolus feeds |
| Continuous method | Slow steady drip by pump over 16-24 hours | ICU patients and all feeds into the jejunum |
Indications, contraindications and complications
| Heading | Points |
|---|---|
| Indications | Unconscious or ventilated patients; stroke with swallowing difficulty; head, neck or oesophageal cancer; burns and major trauma; severe anorexia; critical illness; low intake for more than a few days |
| Contraindications | Complete intestinal obstruction; paralytic ileus; severe GI bleeding; uncontrolled vomiting or diarrhoea; high-output fistula; shock (unstable blood pressure) |
| Mechanical complications | Tube blocked, displaced or pulled out; nose and throat soreness. Prevent by flushing with water and fixing the tube well |
| GI complications | Diarrhoea, nausea, vomiting, bloating, constipation. Prevent by slow rate, room-temperature feed, hygiene |
| Metabolic complications | High blood sugar, dehydration, electrolyte imbalance, refeeding syndrome in starved patients. Prevent by monitoring and starting slowly |
| Aspiration and infection | Feed entering the lungs causes pneumonia; contaminated feeds cause infection. Prevent by raising the head 30-45° and fresh, clean feeds |
How to give a tube feed safely
- 1Wash hands; prepare the feed fresh, or take it from the fridge and bring to room temperature.
- 2Raise the head end of the bed to 30-45 degrees.
- 3Check the tube position (marking at the nose, aspirate test or X-ray as per hospital rules).
- 4Flush the tube with about 30 mL of clean water.
- 5Give the feed slowly by bolus, intermittent or continuous method.
- 6Flush again with water; keep the head raised for 30-60 minutes after a bolus.
- 7Record the volume given, stools, vomiting and weight; discard leftover feed.
In most Indian wards the dietitian writes a blenderized feed recipe in mL and kcal (for example, 6 feeds of 250 mL at 1 kcal per mL = 1,500 kcal), trains the kitchen to strain it well, and checks that the head end is raised at every feed.
2 marks: “What is a PEG tube?” Percutaneous endoscopic gastrostomy: a feeding tube placed through the abdominal wall into the stomach for long-term enteral feeding.
5 marks: “List the complications of tube feeding and how to prevent them.” Mechanical, GI, metabolic, aspiration and infection, each with one prevention step.
10 marks: “Discuss enteral feeding: routes, types of feeds, indications, contraindications and complications.” Define, table of routes, types of feed and methods, indications and contraindications, complications with prevention, and a blenderized feed example.
If the gut works, use it. Short trip by the nose (NG), long stay through the belly (PEG).