Feeding Tubes 101

Alright, so I’m going to attempt the impossible – take the fear out of understanding the mechanics of a feeding tube. The information in this blog is by no means exclusive, but I’m hoping that after you read this, you’ll fear feeding tubes less whether you are a clinician, a person looking to get a feeding tube, or a carer of someone with a feeding tube. Cutlery is to food, as feeding tubes are to your chosen formula! So, let’s begin!

  1. What is the difference between short- and long-term feeding tubes?

Short term tubes start at the nose (naso-) and either end in the stomach (naso-gastric) or in the small intestine (naso-jejunal). By short-term, we usually mean 4-6 weeks. They dangle down the nose, but can also be nicely taped (check out Simple Patch) to the cheek so they aren’t in the way. These tubes are often inserted at the bedside, but can also be inserted during surgery. 

Long-term tubes start in the abdomen and either end in the stomach (gastrostomy) or in the small intestine (jejunostomy). They either dangle down from the abdomen look like a button on someone’s abdomen (also termed a “low-profile gastrostomy”). Tubes are normally ~ 20 cm long and button tubes around 1-5 cm.

  1. How are long-term tubes inserted?
  • A PEG – percutaneous endoscopic gastrostomy. Inserted by endoscope. Click here to watch an insertion animation video (fast forward to 1:20).
  • A RIG – radiologically inserted gastrostomy. Click here to watch an insertion animation (fast forward to 2:27).
  • A JEJ – surgically inserted jejunostomy. 

Not all gastrostomies are “PEGs”. It’s very important that the correct acronym is used when documenting or handing over the type of tube someone has. 

  1. How are feeding tubes removed?

Short-term tubes can just be gently pulled from the nose. The removal of a long-term tube depends on how it is held in place from the inside (by balloon or non-balloon). So: 

  • If held by an internal collapsible bumper, it can be removed by pulling it out.
  • If held by an internal rigid bumper, it can be removed by endoscope.
  • If held by an internal balloon, the balloon can be deflated (usually with water) and then the tube can be pulled out. Balloon gastrostomies are the easiest tubes to have as they can be changed in the community. Most people will have a balloon gastrostomy as a replacement tube. Also the amount of water in the balloon needs to be frequently (every month) checked and carers / patients can be taught to do this!

  1. What is that plastic disc looking thing on the outside?

This is also called an external flange. It is usually placed on top of the cm marking where the tube is meant to sit for best comfort. Best practice is to leave a coin width or so of space between the skin disc and the abdomen (2-5 mm) and 1 cm of movement in and out. Take note of that cm marking almost daily and if it’s moved by 2 cm less or more, consult your dietitian, nurse, or doctor before taking a feed.

  1. What is the French size?

It’s actually the diameter of the tube from the outside. French sizes range from 3.5-24 french. Obviously the smaller ones are for kids and the bigger ones for adults. The french size is often written on the actual tube itself and definitely worth noting what it is for future reference should you need to buy another tube for replacement. 

  1. How many entry points / ports does a feeding tube have?

It varies depending on the tube. Some can have just one port for formula, medications, and water, whilst others have 3 ports; one for each. Balloon gastrostomies would have a balloon port for inflating and deflating. Some tubes also have a decompression port to vent the tummy when too much gas builds up.

  1. What should a clinician or a carer of someone with a long-term feeding tube document when a new tube is put in?
  • Brand of the tube
  • French size of the tube (cm)
  • Device size (cm)
  • Number of ports
  • Removal method (i.e. is the internal flange a bumper / balloon?)
  • If it’s a balloon tube, record mls of water
  • Skin disc (or external flange) cm marking

Always make sure you have a replica or two of your feeding tube. In the instance you need a replacement, it’s much easier to take your new tube with you to get it inserted at your specialists clinics, hospital, or in your home.  

  1. Where can I go for more information?

Happy reading and home tube feeding,

Tube Dietitian.