their desires. An advance directive allows a person
to establish in writing his or her desires about
such matters, mitigating family conflict about
making the decision on behalf of the person.
Types of Feeding Tubes for Enteral NutritionA nasogastric tube is a thin, flexible catheter the
doctor inserts through the NOSE, down the back of
the THROAT, through the ESOPHAGUS, and into the
STOMACH. The insertion process is somewhat
uncomfortable but does not require anesthetic,
though the doctor generally sprays a topical anes-
thetic on the back of the throat to numb the gag
REFLEX. A nasogastric tube is for short-term use,
usually no longer than a few weeks. The nasogas-
tric tube blocks the nostril through which it
enters, and becomes irritating to the nasal mucosa
as well as the SKINaround the nostril.
Surgically inserted tubes are for long-term use
and are generally somewhat sturdier though still
narrow and flexible. They enter the stomach or
SMALL INTESTINEthrough an opening in the abdomi-
nal wall. The most common type is the percuta-
neous endoscopic gastrostomy (PEG) tube, also
called a gastrostomy tube or G tube, for long-term
use. With the person under general ANESTHESIA,
the doctor makes a small incision through the
abdominal wall for the insertion of the tube. An
endoscope passed into the stomach via the throat
and esophagus guides the doctor in placing the
tube. A small balloon at the tip of the tube,
inflated with saline solution, lodges the tube in
the stomach. The surgical wound, called a stoma,
heals in 7 to 10 days.
A gastric button is an alternative to a PEG tube.
After the stoma is completely healed, the person
can remove the tube and replace it with a gastric
button, a pluglike device that fits into the stoma to
block the opening. At feeding times the person (or
caregiver) removes the button, reinserts the tube,
and administers the enteral nutrition solution.
Some people find a gastric button more discreet
and less intrusive. A third surgical alternative is a
tube placed into the JEJUNUM, the middle segment
of the small intestine. A jejunostomy tube, or J
tube, may be necessary for a person who has had
a GASTRECTOMY(surgical removal of the stomach)
such as to treat STOMACH CANCER, or has severe GAS-
TROESOPHAGEAL REFLUX DISORDER(GERD) that negates
a PEG or other gastric tube. Because the small
intestine accepts limited volume, enteral nutrition
via J tube is a continuous infusion.
Conscientious PERSONAL HYGIENEis essential with
either kind of tube to prevent skin irritation
(around the nostrils with a nasogastric tube and at
the stoma site with a surgically placed tube) and
INFECTION (more of a concern with a surgically
placed tubes).Enteral Nutrition Feeding
Enteral feeding may be continuous or intermit-
tent, depending on the person’s health status and
NUTRITIONAL NEEDS. Enteral nutrition administered
via surgically inserted tubes can provide adequate
sustenance for years. Commercially prepared
enteral nutrition solutions, most of which require
a doctor’s prescription, are of appropriate viscosity
to avoid clogging the tube. They have high nutri-
tional density and are available in various formu-
lations to meet individual nutritional needs. The
formula and the person’s requirements determine
the frequency and rate of infusions.
In some situations doctors may recommend
enteral nutrition formulas that are palatable
enough to take by MOUTH, typically in situations in
which a person has difficulty chewing or swallow-
ing and does not want a feeding tube, or who gen-
erally gets adequate nutrition from eating but
would benefit from the nutritional boost of an
enteral nutrition formula. Some products are
available over the counter (OTC) without a doc-
tor’s prescription. Because excesses of some nutri-
ents can cause health problems or interfere with
prescribed medications, people who are consider-
ing such OTC products should discuss the
approach with their doctors first.
See also ENDOSCOPY; NUTRITIONAL ASSESSMENT;
PARENTAL NUTRITION.feeding tube See ENTERAL NUTRITION.food–drug interactions See DRUG INTERACTION.hunger The body’s physiologic indication that it
needs energy (food). Hunger occurs when the
STOMACHand SMALL INTESTINEare empty and mani-
fests as physical sensations of discomfort and even
PAINthat result from contractions of the stomach.hunger 183