What is a feeding tube?

A nasogastric tube is a thin, flexible plastic tube made of silicone or polyurethane, for example. The tube is usually about 75 centimeters long and only a few millimeters wide. With the help of a nasogastric tube, you can artificially feed a person or give him medication if it is no longer possible to take it in the normal way through the mouth. In addition, a gastric tube can be used to drain gastric juice, for example during an operation.

Doctors place the tube over the nose, mouth, and esophagus, or over the skin of the abdominal wall in the stomach. However, it can also be placed in the duodenum or jejunum - both are sections of the small intestine. The prerequisite for the use of a nasogastric tube is that digestion and the absorption of nutrients via the intestine are still functioning properly.

Patients then receive a specially formulated tube feed via the gastric tube. It is supposed to ensure the basic supply of the body with all important nutrients ( fats , proteins, carbohydrates , vitamins and minerals). A feeding tube can also be used for special diets that are geared towards a patient's individual metabolism.

By the way, doctors are not allowed to put the feeding tube just like that, but need the consent of the patient to do so. If he is unable to express himself, doctors and relatives have to speculate what the patient's personal will is. A living will , in which the wish of the person concerned was recorded, is helpful in this case.

Parenteral and enteral nutrition

Artificial feeding with a nasogastric tube can be necessary for various diseases. Examples are swallowing disorders after a stroke or intensive medical treatment. But doctors also use gastric tubes for diagnostic purposes, for example to detect gastric bleeding or to determine the composition of gastric juice.

There are two forms of artificial nutrition:

• Enteral nutrition : Doctors bypass the mouth and throat, food is supplied through the nose or directly through the gastrointestinal tract (Greek "enteron" = intestine).
• Parenteral nutrition : Here doctors bypass the gastrointestinal tract and the supply of fluids and nutrients takes place via the veins.

Different types of feeding tube

There are different type of feeding tube that differ in their access to the gastrointestinal tract. Doctors advance transnasal tubes through the nose, throat, and esophagus into the stomach, duodenum, or small intestine. They are suitable when artificial nutrition is only necessary for a short time. Doctors place percutaneous probes over the skin of the abdominal wall in the stomach, duodenum, or small intestine. They are intended for longer periods of artificial feeding.

Types of feeding tubes: Transnasal tubes:

• Transnasal tube (nasogastric tube): Doctors insert a soft, thin, and flexible tube into one nostril and advance it to the stomach.
• Nasoduodenal probe (duodenal probe): This probe is located in the duodenum, which is directly connected to the stomach (duodenum = duodenum)
• Nasojejunal probe (jejunal probe ): Doctors place the probe in the jejunum. This connects to the duodenum and makes up a large part of the small intestine.

Types of feeding tubes: Percutaneous tubes:

• PEG probe (percutaneous endoscopic gastrostomy): The stomach is accessed from the outside via an incision in the skin of the abdominal wall (percutaneous = through the skin). A small surgical procedure (endoscopy) is required to insert the probe.
• PEJ probe (percutaneous endoscopic jejunostomy): The jejunal probe ends in the jejunum. Like the PEG tube, it is placed in the jejunum with the help of a special instrument (endoscope).
• JET-PEG probe (jejunal tube through PEG): In this case, the patient already has a PEG probe. However, doctors also insert a feeding tube into the jejunum. The JET-PEG probe therefore consists of two components - a PEG probe and a jejunal probe. This combination is a possibility if a person needs artificial nutrition for a long time.

Gastric tube: how long is it necessary?

How long the artificial feeding via a gastric tube is necessary cannot be said in general terms. It depends crucially on the disease that makes artificial nutrition necessary. Nasal tubes are suitable for nutritional therapy over four to six weeks or when the duration cannot yet be precisely predicted.

PEG, PEJ and JET-PEG probes, on the other hand, lie in the stomach or small intestine for a longer period of time. They are intended for long-term use and doctors have to change them less often - approximately every one to three years, depending on the type of gastric tube. There is no limit to how long artificial feeding is possible. In principle, doctors can use them temporarily or permanently.

Inserting a nasogastric tube - this is how doctors proceed

Doctors only insert a nasogastric tube when it is really necessary and a person can no longer ingest food in the normal way. You first need the consent of the patient, a legally authorized supervisor or the written down in a living will. Doctors are not allowed to artificially feed a person against his will. If the patient is unable to provide any information, for example because he is in a coma, relatives and doctors must assess the patient's presumed will.

Transnasal tubes: place a gastric tube over the nose

A feeding tube can be place through the nose (nasogastric or transnasal tube) or the mouth (transoral feeding tube). Doctors choose the latter if access via the nose is not possible, for example in the case of injuries to the midface.

The doctor usually proceeds in the following steps:

• At the beginning, he usually cools the gastric tube in order to irritate the mucous membranes in the nasopharynx as little as possible.
• Before inserting it, he smears a gel on the gastric tube so that the thin tube slides better.
• He sprays an anesthetic into the area of ​​the nose, mouth and throat - the tube can be inserted into the nostril without pain and without sneezing or gagging.
• The patient is seated and the head is overstretched slightly backwards. The doctor carefully pushes the thin tube of the nasogastric tube forward towards the throat.
• Patients then usually drink a few sips of water. At the same time as the swallowing process, the doctor gradually pushes the tube further into the esophagus up to the stomach (or small intestine).
• Whether the gastric tube is properly seated can be checked as follows: The doctor presses air into the tube with the help of a syringe and listens to the stomach with a stethoscope. You should hear a bubbling sound. Otherwise, an x-ray of the abdomen or the extraction of fluids from the stomach will help . The pH should be acidic (low) when it comes to gastric juice.
• The feeding tube is attached to the nose and cheek with the help of a plaster so that it does not slip.

Doctors also insert the nasoduodenal and nasojejunal tubes this way.

Percutaneous: place a feeding tube over the abdomen

Doctors combine two approaches to insert the percutaneous PEG or PEJ probe: A gastroscopy with a small incision in the abdominal wall:

• They push an endoscope through the mouth to the stomach. The instrument is equipped with a light source and a small camera so that doctors can have a good view of the stomach.
• A small incision is then made from the outside through the skin of the abdominal wall.
• There they insert a small tube and thread into the stomach. They grab the thread with the help of the endoscope, pull it up through the esophagus and out to the mouth.
• There the PEG tube is attached to the thread and pulled back into the stomach via the mouth and the esophagus.
• The thicker end of the PEG tube is attached to the stomach while the thin end is pulled out through the abdominal wall. It is countered with a counter plate and attached to the outside of the abdominal wall. The feeding tube in the abdomen can remain there for a long time.

A PEJ tube is placed in the jejunum in the same way. The correct position can be checked again as with the nasogastric tube: administer air through the tip and listen to bubbling noises with the stethoscope, check the pH value of the gastric secretion or take an X-ray.

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