Tube Feeding - Frequently Asked Questions
is a feeding tube?
may provide nutrition to people who have difficulty swallowing
or unable to eat for medical reasons. A feeding tube is device
which transports liquid nutrition to your stomach. A feeding tube
can be inserted into the stomach (G-tubes), through the nose and
into the stomach (NG-tubes), or through the nose and into the
small intestine (NJ tubes). The NG and NJ tubes are considered
to be temporary and the G tube is considered more permanent but
it can be removed.
In some circumstances,
a person with a feeding tube can continue eating. Here, the feeding
tube is providing additional nutrition because of poor intake
by the patient. However, the majority of feeding tubes are inserted
because the patient has difficulty swallowing and they are unable
to continue eating without the risk of swallowing food into the
to use or not use a feeding tube must be made carefully. Discuss
it with your physician, your family, and other persons important
to you. It is your right to use or not use a feeding tube. For
the persons with severe dementia, a physician must rely on previously
stated preferences in an advanced directive or rely on a family
member to provide information on the patients wishes. Such decision
to use or not use a feeding tube must be based on weighing the
risks and benefits?
tube feeding prevent aspiration pneumonia?
pneumonia is caused by food going into the lungs rather than the
stomach. Aspiration pneumonia is common in persons with advance
dementia and often indicates that persons are dying. Surprisingly,
there is no evidence that tube feedings prevent aspiration pneumonias.
Even if tube fed, you are always producing saliva. Tube feeding
doesn't correct the swallowing problem with dementia and you are
still at risk of aspiration pneumonia. Research has found that
persons, despite feeding tubes, a dementia patient still has a
high risk of aspiration of pneumonia.
Does tube feeding prolong a person's
that tube feeding is beneficial if the patient has a reversible
illness, which is usually not the case in patients who have advanced
dementia. If a person is actively dying, their body no longer
absorbs nutrients and cannot utilize the nutrients for the work
of the body. Therefore, tube feeding at the end stages of dementia
may not be beneficial in prolonging a persons life. Vigorous hand
feeding for some persons can prevent the use of a feeding tube.
Stopping or not starting a feeding tube in someone who can't be
hand fed will result in death. In making a decision regarding
the use of feeding tube, ask for a swallowing evaluation by a
specialist. There are no easy answers. You should discuss it with
your physician, family, and other persons.
Does tube feeding increase quality of life and
can cause discomfort, the need for physical restraints to prevent
the tube from being pulled out, and increased risk infection.
Terminally ill patients rarely experience hunger or thirst. Of
those who do, relief is achieved with small amounts of food and
fluids or by ice chips and lip lubrication.
tube-fed patients with advanced dementia may miss the human contact
that comes with assisted oral feeding.
Are There Alternatives to Tube Feeding?
Getting an appropriate
evaluation is key.
may reduce eating difficulties. Some drugs, such as sedatives,
tranquilizers and anti-cholinergics, may cause difficulty swallowing.
as medication adjustments, use assistive devices, changing the
type of food, proper feeding technique, and dental care may prevent
the use of a feeding tube. Useful techniques include the use of
finger foods and preferred foods, strong flavors, hot or cold
rather than tepid food, gravy or juices and enrichers such as
cream. Other helpful techniques are reminders to swallow and swallow
multiple times per bolus, gentle coughs after each swallow, bolus
size of less than 1 teaspoon, liquid supplements and facilitation
techniques such as vibration, gentle brushing and icing of the
cheeks and neck may help. Get an feeding specialist, usually a
speech therapist, is important first step.
Where do I turn for help?
Support can come from your family and professionals who can offer
guidance and assist with this kind of decision making, such as
your physician, nurse, social worker, speech therapist, chaplain,
or dietitian. Support from clergy often helps guide a family through
this decision. In addition, some hospitals and nursing homes have
ethics committees who can assist with decision making on alternative
The best advice is
for persons to state preferences for the use of a feeding tube
in an written advance directive.
for additional information:
House Handbook for Mortals: Tube Feeding
Association: Tube Feeding
and Conversations. A Consumer Guide to End-of-Life Care