Feeding Tubes: Types, Placement, What to Know

Among the conditions that may require use of a feeding tube are:

• Gastrointestinal cancers
• Serious cases of Crohn’s disease
• Injuries that affect your digestive system
• Intestinal failure
• Narrowing of your esophagus (the tube that connects your throat to your stomach) or elsewhere in your digestive tract
• An obstructed bowel
• Short bowel syndrome
• Head and neck cancers
• Stroke
• Paralysis 
• Serious eating disorders

You also might need a feeding tube when you're recovering from surgery that affects your ability to eat or digest, or if you're unconscious or in a coma.

Feeding Tube Types

Feeding tubes differ both in where they’re inserted into your body, and the type of procedure your doctor uses to place them. In general, those that go through the nose or mouth are for people who need a feeding tube for less than 6 weeks. If you'll be using one longer than that, you’ll likely need surgery to insert it into your stomach or bowel.

Types of feeding tubes include:

• Nasogastric tubes. These tubes are inserted through your nose and into your stomach. They’re used for short-term feeding and to deliver medications while you’re in the hospital.  
• Nasojejunal tubes (NJT). This type of tube runs from your nose to a section of your small intestine called the jejunum. You might get this type after pancreatic surgery or if you have a small intestinal blockage. 
• Nasoduodenal (ND) tubes. They go from your nose to your duodenum, another part of your small intestine. 
• Orogastric (OG) tubes. These feeding tubes are similar to the nasogastric type, but are inserted into your mouth and down into your stomach. They’re intended for short-term use. 
• Oroenteric tubes. Like OG tubes, these are temporary tubes placed through your mouth, but the tube goes into your small intestine.
• Gastric (G) tubes: Your doctor inserts this type of tube using surgery. They run through the skin of your belly and into your stomach. Like other surgically placed tubes, they’re meant for longer-term tube feeding. 
• Jejunostomy (JEJ, PEJ, or RIJ) tubes. A surgeon places these tubes into your jejunum. You might get one if you’ve had surgery on your esophagus or stomach. 
• Percutaneous endoscopic jejunostomy (PEJ) or percutaneous endoscopic gastrostomy (PEG) tubes. This type of tube is inserted with endoscopic surgery, meaning that the surgeon uses a tiny camera to help place it. 
• Radiologically inserted gastrostomy (RIG) or radiologically inserted jejunostomy tubes (RIJ). If you can’t have an endoscopy, the doctor can use imaging similar to an X-ray to put the tube in the right place during surgery.
• Percutaneous endoscopic gastrojejunostomy (PEG-J) tubes. Your surgeon inserts the tube through your skin into your stomach, then through the stomach into your jejunum. You’re left with one opening, or port, leading to your stomach, and another to your small intestine. You might get a PEG-J if you have serious gastric reflux disease (GERD) or part of your stomach has been removed. 

Your feeding system might deliver nutrition into your body by way of: 

• A gravity bag. These bags hang from an IV pole or hook. When they’re filled with formula, gravity moves it down the tube and into your body. 
• A feeding syringe. A syringe connected to your feeding tube sends formula into your body. It includes a connector or valve to regulate the feedings. You might also hear this called bolus feeding.
• A bag and pump. A pump pushes formula from a bag into the feeding tube. It’s sometimes used for continuous feeding, which runs for 24 hours a day. 

Feeding Tube Placement

Surgery to insert a feeding tube is generally fairly simple. Your surgeon cuts through the skin of your belly and places the tube into your stomach or intestine.

Your doctor will probably tell you not to eat or drink anything for 8 hours before your operation. At the hospital, you’ll be asked to take off eyeglasses and dentures.

You’ll get a mixture of a painkiller, a sedative, and an antibiotic through a tiny tube into your vein. Your doctor also will give you a shot of an anesthetic (a pain-numbing drug) in the part of your body where the feeding tube will go in. You may not be fully conscious for the procedure.

In most cases, your doctor will perform the surgery endoscopically. They’ll thread an instrument called an endoscope through your mouth and into your stomach. The camera on the end of the endoscope allows them to see your stomach or intestinal lining to find the best spot for the tube. They then make a small cut in the abdominal wall to insert it.

The surgery usually lasts about 30-45 minutes.

Feeding Tube Placement Recovery

Your doctors will watch you closely for any signs of infection, bleeding, or other complications.

Your doctor will tape the feeding tube to your belly. You might see some drainage around it for the first day or two. A sterile gauze will cover your cut, and your nurse will change the dressing as needed. Once the dressing comes off and your wound has healed, you’ll need to wash the area daily with soap and water.

Your abdomen may be a bit sore for a couple of days where the tube went in. It might feel like a pulled muscle. Your doctor will give you pain meds for the first day after the surgery.

Usually, your feeding tube won’t need to be replaced for several months. You may even have it for 2-3 years.

Your Diet

You’ll likely use a formula with calories and nutrients tailored for you. You can buy what’s called an enteral formula in a can. Most are made to flow well through a tube.

With your doctor’s OK, you can make your own formula in the blender. You’ll need to make sure it has the recommended calories, vitamins, minerals, fiber, and fluids.

Other liquids can go into a tube, too:

• Almost anything clear, such as water and club soda
• Enzyme treatments
• Fluids that replace electrolytes, like sports drinks
• Juice

Most meds can go through a tube. Some come as liquids. You may be able to crush or dissolve pills and put them into the feeding tube, but talk to your doctor first.

Feeding Tube Use and Care

When you're in the hospital, doctors and nurses will take care of your feeding tube. If you're going home with one, a home care provider – nurse, dietitian, or other helper – will give you specific instructions on how to use and care for your tube. 

For most kinds of feeding tubes, you'll follow these care procedures:

Clean your hands. Always use soap and water or alcohol-based hand sanitizer before you work with the tube. Make sure your hands are dry.

Prevent clogs. This is one of the biggest problems with feeding tubes. Always flush your tube with the suggested amount of water before and after you use it, including when you use it to take meds. You'll need to flush it even on days you don't use it.

Watch for infections. Keep the spot on your skin where the tube goes into your abdomen -- the stoma -- clean and dry. Check it every day for irritation, redness, swelling, or infection. Your doctor may direct you to apply an antibacterial ointment after you clean the area. But in general, avoid using creams and powders around your stoma.

Care for teeth and gums. Even if you get most or all your nutrition from a tube, your oral health is still important. Brush your teeth, gums, and tongue daily, and keep your lips moist with balm or petroleum jelly.

Here are tips for caring for particular types of feeding tubes: 

Nasal tubes: Use a clean washcloth to wipe the skin around the tube and remove any crust or secretions after each feeding. If the area gets irritated, you can place the tube through the other nostril. A nurse or other health care provider can show you how.

G tubes: Clean the skin around the tube one to three times a day. Using a clean, soft cloth or piece of gauze, and wipe gently in circular motions. Start next to the tube and work outward. If you use an absorbent pad in the area, replace it at least once a day. 

J tubes: Clean your stoma area at least once a day using a cotton swab or towel. If you notice drainage, apply a piece of gauze after cleaning.  

PEG and PEGJ tubes: Always use tape or a fixation device to keep the tube in place. If it comes out, your stoma can close up. To prevent your tube from getting stuck in the lining of your digestive tract, push it in and turn it every so often. You don't need to turn a PEGJ tube, but push it in periodically.

Feeding Tube Side Effects

You might have some discomfort or pain when you first get your feeding tube. Other possible side effects include:

• Irritation to your nose or the lining of your digestive tract
• Nausea, cramps, or stomach problems like diarrhea or constipation
• Dehydration
• Infection at your surgical site
• Leakage from your stoma
• A blockage of the tube
• Dislocation of the tube 

To address these issues, your doctor may suggest you check that your tube is placed correctly or switch to a different formula or amount. They can also prescribe medication to help you feel better.

It’s not common, but you could also get serious complications such as aspiration pneumonia (which happens after you get food or liquid into your airways) or damage to your intestinal wall.  

When to Call a Doctor

Let your doctor know right away if:

• Your tube comes out or gets dislodged.
• Food won’t pass through the tube.
• You see leaks around the tube.
• Your stomach is bloated or you’re vomiting.

Quality of Life With a Feeding Tube

When you can’t eat the same way as everyone else, it can change your social life and make you feel left out. You may miss the taste of food. You may also feel self-conscious about your tube. You might need to rethink how you do everyday things like dining in restaurants and traveling.

Shared meals. This can be a tricky adjustment. If you’re on the road, carry a wallet-sized card to quickly describe why you’re not eating or eating in a different way. If you’re comfortable at social meals, others likely will be, too. Some people hook up their pump and eat along with everyone. Others even travel with a blender and ask the kitchen to blend the dishes.

If you aren’t comfortable using your feeding tube in public, ask the manager if there’s a private place for you to go. Under the Americans with Disabilities Act, the restaurant legally must fill any reasonable requests.

Intimacy and sex. Open communication and a bit of planning can help you and your partner keep your emotional and physical relationship on track. For instance, schedule a time together for when you’re not taking in food. If your doctor hasn’t discussed sex with you, bring it up.

Stay active. Tube feeding doesn’t need to keep you from most physical activities. You can run or walk, but talk to your doctor about yoga or other exercises that work your abdomen muscles. Even swimming is fine if your incision site has healed and the water is clean. Nasal feeding tubes have no restrictions on swimming other than making sure the tube is closed, clamped, and not hooked up to a feeding pump. Ocean water and well-maintained private pools are your best bets if you have a feeding tube in your abdomen. Stay away from hot tubs, as they teem with microorganisms that can cause infection.

Seek support. Family and friends can give you confidence to adjust to your new life. You need support, but also encouragement to stay independent. You might want to get advice and help from a specialist who works with feeding tube users. This can be a psychologist, a nurse, or someone else in the community.