Feeding Tubes

Different Types of Feeding Tubes

The type of feeding tube used depends on how long a patient  will be tube fed and whether or not the stomach or intestines can tolerate the needed volume of food. I have gathered this information from various of websites in the hope that it helps some people. I have had all of these tubes done myself and at the time I felt alone and knew very little about it. I have put up videos as well to show and help people of how theses tubes are place. I hope it help! Please leave a comment and share if you have any further questions or want to know about my experience feel free to contact me x

NG (Naso Gastric): Runs from the nose to the stomach

An NG tube is a narrow, flexible tube that is placed through the nose and down the esophagus, ending in the stomach.The tube is temporary, requires no surgery or anesthesia to place, and may be removed at any time.   

NG tube Pros

• Placed non-surgically and patients/carer can be taught how to place an NG tube at home.

• It is a good Tubie for short-term tube feeding. If your going to be tube fed for longer than a few months, you should consider moving to a G-tube.
• —Avoid general anaesthesia
  Speeding up the return of bowel function.
  Easy tube insertion
   

NG tube Cons

• NG tubes need to be changed every 1-3 weeks, rotating sides of the nose.

• Little hands (babies/or by accident) pull the tube out. 

• Taping the Tubie can be a challenge. It may not stick well. Sometimes there is a reaction on the skin from the tape. There is some trial and error to finding what works for you. Moreover, some people are allergic to tapes used. 
  

• There can be congestion in the nose and eye on the side where the NG tube is.

• The NG tube can make reflux worse because it holds the stomach open to the esophagus. 

• It is the most visible of the Tubies and therefore it can draw attention in public. People may confuse it with oxygen. And patin may feel self conscious.

NJ (Naso Jejunal): Runs from the nose to the intestines       

NJ tubes are like NG tubes, only longer.  Instead of terminating in the stomach, the tube is threaded through the pylorus, the valve between the stomach and the small intestine, and then pushed forward into the middle part of the intestine, called the jejunum.  In some cases, it may only be put in as far as the first part of the small intestine, the duodenum.  This is called a Nasoduodenal tube (ND).                                                                      

NJ tube Pros: 

• Non-surgical

• Can serve as a trial run before moving to a more permanent tube, such as the GJ

NJ tube Cons:

• Because the tube is run to the intestines, it needs to be placed by Interventional Radiology using x-rays to insure correct placement. Some hospitals perform this procedure under sedation, some hospitals do not. You will need to check with your hospital. 
• Similar cons to NG tube.

• You will be continuously fed. There is no bolus feeding to the intestines. Your can be off as many as 6 -8 hours. Feeding schedules vary based on nutrition and hydration needs. 

• It is a bigger deal if the is pulls out by accident because you will need to get it placed by Interventional Radiology. 

• You have all the tape cons like an NG

ND (Naso Duodenal): Runs from the nose to the entrance of the intestines 

• Not a common Tubie. Has the similar pros and cons to the NJ and NG.

G (Gastric): G-tube is surgically placed directly into the stomach. Some hospitals will place a PEG or Bard G tube initially to form the stoma (2-3 months) and then transition over to a button g-tube. 

G tube Pros:

• It is more comfortable than the NG because it eliminates the tape on the face 

• Parents can easily learn how to change the tube at home 

• Buttons can last about 3 months or so 
• Maybe used for long term support

• If your not feeding, no one would know they are a Tubie. Low profile buttons do not stick out very far making it more comfortable for the child.

G tube Cons:

• It does involve a surgical procedure to place a G tube initially. However, we have found that our children have healed quickly from the procedure and resumed normal activity fairly quickly. 

• Little hands can also pull out G tubes! 

• G tubes need to be "vented" to release gas from the stomach. Think of it as belly burping. 

• G tubes can clog. So be sure you "flush" medications with 7-8mls of water. 

• Granulation tissue - it looks like little blisters and redness around the stoma and it can be very sore.

• Some docs/surgeons will tell you that you need to have a Nissen Fundoplication at the same time - NOT TRUE!!!!! 

GJ (Gastric Jejunal): Button is placed stomach and tubing runs to the intestines, using the existing G stoma.    

            

GJ Tube Pros:

• Feeds directly to the intestines which is important for kids with delayed gastric emptying or dysmotility

• The G tube can be converted into a GJ easily (no new surgery)

• No more vomiting formula fed by Tubie!!!! (exception might be children with Chronic Intestinal Pseudo Obstruction and if tube has a complication)

• GJs can be an alternative to a Nissen Fundoplication for children who aspirate

GJ Cons: 

• Tube is placed by Interventional Radiology using x-rays to insure correct placement. Like the NJ tube, some hospitals perform this procedure under anesthesia

• GJs need to be replaced about every 3 months

• Since GJ placement is key, more care needs to be taken to not to keep the button on the tummy as stationary as possible. GJs should not be turned. 

• GJs can coil up and migrate to the stomach if the J part isn't long enough - Seek medical attention immediately if you see formula in G output or venting. 

• It is a bigger deal if a GJ tube clogs. It is recommended that a GJ be flushed every 4-6 hours with 15mls of water through a syringe. This should be done less quickly than a flush to the G. Water going through quickly can affect placement.

• You will be continuously fed. There is no bolus feeding to a GJ. You may be off as many as 6-8 hours. Feeding schedules vary based on nutrition and hydration needs, and if your able to eat or drink anything orally.

• It is likely you will still need to vent the G port 

• In rare cases, continuously venting or draining of the stomach is needed. 

J (Jejunal): Button can be surgically placed directly into the intestines or into the stomach like a GJ           

J Tube Pros:

• See GJ Pros

J Tube Cons:

• J tubes without G ports cannot be vented. So if there is build up of gas in the stomach it cannot be released

• J tube sites can have more problems with leakage than G tube sites. 

TPN: Total Parenteral Nutrition                                                                                                                                 

This is a last resort for people who are unable to tolerate tube feeding into their stomachs or intestines. It involves the placement of a central line and nutrition is fed intravenously. In some cases it is used temporarily until a person is able to tube feed again. In other cases, TPN becomes the main nutritional support. TPN can be administered at home once a patient or carer is trained. 

TPN Tube Pros:

• ——Needed when GI tract is non –functioning

TPN Tube Cons:

• Catheter associated infections
• —Air Embolism
  Circulatory overload
  —Hyperglycemia
  —Hypoglycemia
  —Catheter Occlusion
  —Pneumothorax (central line)
  —Venous thrombosis
  —Infection
  —Fluid and electrolyte complications

Information gathered ere are from the following websites.
http://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&sqi=2&ved=0CHMQFjAH&url=http%3A%2F%2Fwww.amtinnovation.com%2FAACNPresentation.pps&ei=9hCCU9nzDOLF7AaomIHgCA&usg=AFQjCNHyd-ipIL4jsFmD5rzKT5tPb3KSOQ&sig2=GMHYdekYGIzKIYK0TwLBfw&bvm=bv.67720277,d.bGE

http://articles.complexchild.com/aug2009/00144.html

http://www.feedingtubeawareness.com/different-types-of-feeding-tubes.html#anchor_193