Today we are going to discuss some basic information on feeding tubes with the pediatric population. This information is a background about working with children with feeding tubes. Our objectives include:
- You will be able to list five alternative means for nutrition and hydration.
- You will be able to list three complications that can arise from tubes and tube feedings.
- You will be able to list three steps in the process of transitioning a child from tube feedings to oral intake.
History of Feeding Tubes
Let's review the history of tube feedings. I am going to refer you to the Chernoff article from 2006 that's listed in the references. It's a very interesting article describing how tube feedings have progressed over the many, many years that they've been utilized.
The use of feeding tubes dates back to ancient Greece and Egypt. You can imagine how rudimentary those tubes must have been at that time based on what we now know about the whole gastrointestinal system.
When there was an option to do an NG tube or a G-tube, NG tubes were initially favored because there were too many difficulties occurring with G-tubes when the procedure was first developed. Then in the 1940's there were more formulas being developed to meet the specific needs of children, and people in general, for their tube feedings.
Types of Feeding Tubes
Let's review some of the types of feeding tubes that we might come across working with pediatric patients.
Central Line/TPN
The first one is TPN, total parenteral nutrition, or also called a central line. This type of feeding system is going to bypass the gastrointestinal system. Often, it is used with children who are experiencing surgeries in their gastrointestinal system or may be going through chemotherapy and have a lot of nausea and vomiting. They aren't able to keep food down. The goal is always to resume gastric feeding, go back to regular feedings and not stay on TPN for a long period of time. There can be a risk of infection at the catheter site.
A TPN is usually a central line. However, there could be peripheral placement of the catheter as well. This type of feeding is specialized solutions of proteins, glucose, lipids, vitamins and minerals. Because the solution is not delivered via the gastrointestinal system, a child could still experience hunger since nothing is going into their stomach at that time. However, their nutritional needs are being met with this type of feeding.
Orogastric Tube
The second type of feeding tube is the orogastric tube. From this point forward we are only going to discuss enteral tube feedings, tubes that are introduced into the gastrointestinal system. This is also considered to be a short-term solution to feeding problems.
A tube is going to be passed from the mouth into the stomach. The tube is inserted, the feeding will be completed and then the tube will be removed. When an orogastric tube is in place, a child cannot complete oral feedings at that time because the tube is blocking tongue movement for swallowing. With all of the gastrointestinal tubes we will discuss, it's very normal to flush the tubes with water after a child has received a feeding or if they received medications via that tube.
