# Feeding Tubes



## Jon (Apr 23, 2008)

OK... Question of the day:

What is the difference between a PEG tube, a G-tube, a J-tube, and any of the other "standard" feeding tubes installed in patients who are no longer able to ingest solid food?

What are the likely EMS complications? How about treatment?


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## VentMedic (Apr 23, 2008)

Short-term

NG-tube: nasogastric feeding tube, Levine tube, is passed through the nares, down the esophagus and into the stomach.  
OG-tube: oral gastric, preferred for people on ventilators as part of a Ventilator Associtated PNA protocol.  Also used for infants.

NG and OG: It can be used for feeding and to suction the contents from the stomach.  Great to have during a code to prevent apiration and deflate the air filled stomach from the BVM. 


Sidenote:  Capnometry (colorimetric indicator of end-tidal carbon dioxide) is being used by some hospitals with other methods of tube placement confirmation to keep the tube out of the trachea.  

Complications of NG-Tubes:
epistaxis
sinusitis - lead to infection, fever, drainage: PNA
easily pulled out or  pulled out of position
wrong placement position
Tracheal placement
ASPIRATION

Complications of OG-Tubes:
easily pulled out or pulled out of position
wrong placement position
Tracheal placement
ASPIRATION

If tube feeding required for more than 30 days a more permanent route is done which are gastric tubes. 

Sidenote:  Some cultures may not allow the surgical placement of gastric tubes (ie, Chinese).   Or, tracheostomy tubes either.  

Most nursing homes prefer long term tubes to be gastric due to the decreased apiration risks and restraint usage.  Tieing elderly people up to maintain nuitritional status has its risks including PNA and decubitus ulcers from limited ability to position patient.   Sort of a darned if you do, darned if you don't thing.  

Tube placement may require X-ray confirmation which nursing homes do not readily have access to. 


*G-Tube*: gastric tube, which are inserted through the skin of the abdomen and into the stomach

Types of G-Tubes:

PEG: percutaneous endoscopic gastrostomy tube. An endoscope is passed through the mouth and esophagus into the stomach. The position of the endoscope can be visualized on the outside of the patient's abdomen  by the endoscope's light source.  A suture line is passed by a needle through the abdominal wall for the endoscope to grap and pull back out through the esophagus.  The suture line is tied to the end of the tube that will be external. The tube is then pull through the esophagus and the part meant to be external is pulled through the stomach and abdominal wall.  There is either a balloon or wider end that keeps the tube in place. 

J-tube:  jejunostomy tube, (PEJ: percutaneous endoscopic jejunostomy) which are surgically placed through the abdominal wall into the part of the small intestine called the jejunum.  Less risk of aspiration than usually associated with gastrostomy feedings.

Complications:
infection
The patient may have impaired swallowing ability so aspiration of own oral secretions still occurs leading to all the same complications such as PNA and infection from repeated suctioning (introduces bacteria from nares closes to the trachea and lungs). 

As an RT, feeding tubes are our best friends but can be our worst enemy.  Airway complications and infection can lead to PNA, ARDS and sepsis.


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## AnthonyM83 (Apr 25, 2008)

VentMedic, I love your posts. TY


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