When is a feeding tube used as a treatment?
When the underlying cause of the inability to swallow is thought to be reversible, the feeding tube is used as a treatment. At some times the problem will be caused by surgery or by a stroke and recovery is expected.
Can a feeding tube be discontinued to prolong life?
In the absence of a progressive terminal disease, the feeding tube may be used to prolong life. Since the patient is not dying of another cause, discontinuing the feeding tube would imply a desire to cause the patient’s death.
Can a debilitated patient be deprived of a feeding tube?
They should not be deprived of this for the convenience of a feeding tube. The burdens of a feeding tube include the minor discomfort of its insertion and diarrhea that is often caused by tube feeding. In a debilitated patient who is not able to get prompt nursing care, diarrhea may increase the incidence of skin break down or bedsores.
What is the state of being fed by a feeding tube?
The state of being fed by a feeding tube is called gavage, enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. A variety of feeding tubes are used in medical practice. They are usually made of polyurethane or silicone.
Is tube feeding considered medical?
Tube feeding is now legally regarded as medical treatment. The provision of nutrition through nasogastric or gastrostomy feeding tubes is not part of basic care according to several recent court decisions.
When did feeding tubes start?
Although supplemental enteral nutrition may have first been delivered by enema, the modern era of surgically placed feeding tubes began in the mid to late 1800s.
What does the Catholic Church say about feeding tubes?
The church's view is that giving food and water to a person through a feeding tube is not medical intervention but basic care, akin to keeping the patient clean and turning him to prevent bedsores, Pacholczyk said.
Who changes feeding tubes?
Your doctor or nurse will need to change the tube in the office using special tools, such as an obturator. If your child has a balloon button or tube and has had the device for at least two months, you may be able to change the tube at home. Ask your doctor or nurse for instructions on how to change the tube.
What is the difference between NG tube and feeding tube?
Types of Feeding Tubes Gastrostomy tubes, also called G-tubes or PEG tubes, are short tubes that go through the abdominal wall straight into the stomach. Nasogastric tubes, or NG tubes, are thin, flexible tubes inserted through the nose that travel down the esophagus into the stomach.
Who inserted the first feeding tube?
John Hunter, a Scottish surgeon and comparative anato- mist who practiced in England, created an orogas- tric tube made of whalebone covered with eel skin. Gastrostomy as a surgical procedure was proposed by several surgeons, including Charles Sédillot, a French surgeon, in 1846.
Can you refuse a feeding tube?
Ethically and legally patients have the right to refuse life-sustaining treatment, including artificial nutrition and hydration. The Patient Self-Determination Act (1991) is a federal statute that reinforces patients' rights to refuse artificial hydration and nutrition.
What is the Catholic Church's view on artificial nutrition and hydration?
Directive 58 applies the definitions from Directives 56 and 57 to artificial nutrition and hydration (ANH). In brief, Directive 58 says that there should be a presumption in favor of providing nutrition and hydration as long as "this is of sufficient benefit to outweigh the burdens involved to the patient" [2].
What do Catholics believe about sustaining life in a vegetative state?
In an interview with Vatican Radio, the doctrinal department's undersecretary, Father Augustine Di Noia, rejected arguments that the life of someone in a vegetative state was not worth living and therefore could be ended.
Can an RN replace a G tube?
Q: Is it okay for a nurse to replace a gastrostomy tube? A: Carol McGinnis, RN, MS, CNSC, replies: Replacing a gastrostomy tube is within the scope of practice of registered nurses on a state-specific basis. Thus, it is important to review your state's nurse practice act in this regard.
How often do G tubes need to be changed?
every six to eight monthsA low-profile balloon G tube sits close to the skin and is easy to conceal. Balloon G tubes should be changed at least every six to eight months to prevent the balloon from leaking or breaking, which can cause the G tube to accidentally fall out. The G tube feeding extension set should be changed every month.
How long can a person live on a feeding tube?
A feeding tube can remain in place as long as you need it. Some people stay on one for life.
What are the risks of tube feeding?
What are the risks? An October 13, 1999 report in the Journal of the American Medical Association found that the most common adverse effect associated with all types of tube feeding is aspiration pneumonia. For percutaneous endoscopic gastrostomy (PEG) tubes, common adverse effects are tube occlusion, leaking, and local infection. Approximately two-thirds of nasogastric tubes require replacement, according to the JAMA report.
Has PEG use increased?
Experts say that PEG use has increased exponentially in the past two decades, and that decisions like those facing the parents of Dylan Walborn are far more common than the public may suppose.
Do hospitals have to report feeding tubes?
Even less is known about the number of people who choose to pull feeding tubes. Although hospitals are required to convene ethics panels to determine patient treatment, there is no reporting requirement or repository for this information.
Should feeding tubes be terminated?
Yet the concept of a feeding tube as medical treatment – one that can and should be terminated when the risks outweigh the benefits – is likely to run counter to a deeply-entrenched belief that the provision of food for those who cannot nourish themselves is an essential human necessity, and a staple of ethical medical care.
Is a feeding tube a medical procedure?
But Dr. Parsons and other experts emphasize that use of a feeding tube – a medical procedure requiring surgery and technical expertise – is accompanied by risks and benefits that are likely to vary depending on the individual patient, the nature of the condition, and the medical facility.
Is a feeding tube mandatory for a demented patient?
Dr. Bernat noted that the AAN does not have a position specifically on feeding tubes but the issue is discussed in a paper on the ethical aspects in care of demented patients, “Ethics Issues in the Management of the Demented Patient,” available online on the AAN site ( www.aan.com; select Ethics/Position Statements). It says basically that inserting a feeding tube is not mandatory for a severely demented patient who no longer can eat , although offering and encouraging oral feeding should be done.
What is a feeding tube?
A feeding tube is a medical device used to provide nutrition to people who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. The state of being fed by a feeding tube is called gavage, enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions ...
What are the conditions that require tube feeding?
The more common conditions that necessitate feeding tubes include prematurity, failure to thrive (or malnutrition), neurologic and neuromuscular disorders, inability to swallow, anatomical and post-surgical malformations of the mouth and esophagus, cancer, Sanfilippo syndrome, and digestive disorders.
How long does a nasogastric tube last?
This type of feeding tube is generally used for short term feeding, usually less than a month, though some infants and children may use an NG-tube longterm. Individuals who need tube feeding for a longer period of time are typically transitioned to a more permanent gastric feeding tube. The primary advantage of the NG-tube is that it is temporary and relatively non-invasive to place, meaning it can be removed or replaced at any time without surgery. NG-tubes can have complications, particularly related to accidental removal of the tube and nasal irritation.
What are the different types of feeding tubes?
Types. The most common types of tubes include those placed through the nose, including nasogastric, nasoduodenal, and nasojejunal tubes, and those placed directly into the abdomen, such as a gastrostomy, gastrojejunostomy, or jejunostomy feeding tube .
Why are feeding tubes used in the ICU?
Feeding tubes are often used in the intensive care unit (ICU) to provide nutrition to people who are critically ill while their medical conditions are addressed; as of 2016 there was no consensus as to whether nasogastric or gastric tubes led to better outcomes.
Where is the nasojejunal tube?
A nasojejunal or NJ-tube is similar to an NG-tube except that it is threaded through the stomach and into the jejunum, the middle section of the small intestine. In some cases, a nasoduodenal or ND-tube may be placed into the duodenum, the first part of the small intestine. These types of tubes are used for individuals who are unable to tolerate feeding into the stomach, due to dysfunction of the stomach, impaired gastric motility, severe reflux or vomiting. These types of tubes must be placed in a hospital setting.
Where is the feeding tube inserted?
A jejunostomy feeding tube ( J-tube) is a tube surgically or endoscopically inserted through the abdomen and into the jejunum (the second part of the small intestine ).
Why discontinue feeding tube?
In the absence of a progressive terminal disease, the feeding tube may be used to prolong life. Since the patient is not dying of another cause, discontinuing the feeding tube would imply a desire to cause the patient’s death. It is in this context that most of the controversy occurs.
What happens if you use a tube feeding tube?
If the feeding tube is used in a patient who has a progressive terminal illness the tube may only delay death and the use of a feeding tube may simply prolong or increase the agony. The operative words are “progressive terminal illness,” which would include such conditions as cancer; kidney, heart, or lung failure. It would also include dementia and advanced age. It does not include someone who is stable though disabled after a brain injury or stroke. In the context of progressive terminal illness it can be argued that tube feeding should generally not be done. When the patient dies the ultimate cause of death is the underlying disease, not starvation or dehydration.
Why do you need to feed a tube after esophageal surgery?
Similarly, there are very few who would recommend tube feeding when the patient cannot eat because of an esophageal blockage caused by an untreatable cancer. ...
What are the burdens of a feeding tube?
Burdens of feeding tubes: The burdens of a feeding tube include the minor discomfort of its insertion and diarrhea that is often caused by tube feeding. In a debilitated patient who is not able to get prompt nursing care, diarrhea may increase the incidence of skin break down or bedsores.
What makes tube feeding unique?
What makes tube feeding unique is that the benefit may be huge while the burden is typically small.
How long does it take for a baby to swallow on its own?
Nevertheless, it may be appropriate to insert a feeding tube, hoping that perhaps within three months she will be stronger and able to swallow on her own. In three months, if she is not able to do that, we want to honor her wishes and discontinue the feeding tube.
Why is it important to provide food and fluid?
Food and fluid have a definite symbolic role; they imply care. It is satisfying to know that we are meeting the needs of our loved ones. Choosing not to provide food and fluid can be distressing. Right and wrong, however, are not determined by “our feelings” or the “symbolic” value of the feeding tube. We do not seem to struggle in the same way with providing a respirator to the dying, yet air is of more immediate value than food and water.
What is the Catholic Church's tradition of discontinuing medical procedures?
At the end of the 20th century, the Catechism of the Catholic Church upheld this tradition: “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘overzealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected” (#2278).
When did Pope Pius XII use ventilators?
In 1957 , Pope Pius XII applied this tradition to the use of ventilators: “But normally, one is held to use only ordinary means—according to circumstances of persons, places, times, and culture—that is to say, means that do not involve any grave burden for oneself or another.
Has the Vatican changed the hydration directives?
Regarding artificial hydration and nutrition, the Ethical and Religious Directives for Catholic Health Care Services in the United States have not been changed; there has been no instruction from the Vatican to change them. TheseDirectives (United States Conference of Catholic Bishops, fourth edition, 2001) state: “There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient” (#58).
Is artificial nutrition and hydration morally obligatory?
If patients are not dying, he said, artificial nutrition and hydration must be considered “in principle, ordinary and proportionate and, as such, morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.”
Why do people use feeding tubes?
In many cases, feeding tubes help prevent illness and prolong life. In diseases like ALS, feeding tubes can be a normal part of treatment, as swallowing may be compromised before a person is in the end stages of the disease.
How long does it take for a person to stop eating after a feeding tube?
If the person is totally unable to eat and does not use a feeding tube, the body will slowly shut down over a period of one to two weeks. Comfort measures are given, so the patient does not suffer, and hospice care can help the patient and family.
What is NG tube?
Patients may be fed during hospitalization with an NG Tube (naso-gastric tube, inserted through the nose and down the esophagus to the stomach ), which allows the patient to receive liquid nutrition. If swallowing difficulties continue, physicians may discuss the use of a G-tube (gastric tube) with the family.
Can you swallow with a feeding tube?
With or without feeding tubes, patients can learn swallowing techniques to reduce the likelihood of aspirating. Caregivers can also help by preparing “thick liquid” diets (thin cream of wheat, mashed potatoes, thickened broths for example), that are easier to swallow, and by avoiding thin liquids and things that require chewing. Some people can enjoy eating small amounts this way, even when they are receiving their primary nutrition through a tube.
Can a patient choose not to use a ventilator?
One way patients and family members can ease the difficulty of this decision is to choose not to use a ventilator as treatment in the first place. Patients can make their wishes known about this through Advanced Directives and discussions with their physicians and family members.
Can you live with Alzheimer's with feeding tubes?
There is some debate, for example, about whether feeding tubes actually extend life in end-stage Alzheimer’s disease. For many, this is a quality of life issue, and they would prefer to not to live this way.
Can you pull out a tube with dementia?
Some patients truly miss the taste and experience of eating and find normal eating hard to give up. Patients with dementia and/or severe agitation may pull at the tube and/or pull it out, which might require sedation or restraints. And remaining sedentary for the time required to receive the feedings may be difficult.
When is it acceptable to remove tube feeding?
It is morally acceptable to remove tube feeding when the body is no longer able to assimilate feeding.
What is the NGT tube?
E. Nasogastric Tube (NGT) —n utrients are provided into the stomach through the nasal cavity. All these medically-provided nutrition and hydration are also referred to as artificial nutrition and hydration or “tube feeding.”
What does the Pope say about nutrition?
The Pope said that nutrition and hydration is an ordinary or proportionate measure and should be given to any person even those who are in a persistent vegetative state and comatose state . The Pope added that the obligation to provide the usual care due to the sick includes the use of nutrition and hydration.
When did Pope John Paul II make a stand on artificial hydration and nutrition?
Pope John Paul II made a stand on artificial hydration and nutrition on his allocution or speech to the members of the World Federation of Catholic Medical Associations and the Pontifical Academy for Life on March 20, 2004, concerning the provision of nutrition and hydration to PVS patients.
Why do we forego feeding?
The intention to forego feeding when the burdens of the intervention outweigh the benefits is not to bring about death. In this case, we allow the natural process of dying and the progression of illness to take its course. The bodies of such patients begin to shut down and the food may no longer be assimilated by the body. Complications such as repeated aspiration, pneumonia, and infection at the site may occur when feeding tubes are administered for such patients. [14]
What is the purpose of food and liquid?
The primary purpose of the provision of food and liquid is not to cure an illness, but to nourish and hydrate the body so that the most basic physiological and psychological processes of maintaining a person’s well-being can take place.
Which tube delivers nutrients to the small intestine?
C. Jejunostomy (J-tube), — nutrients are delivered to the small intestine through a tube sutured into the abdomen; D. Hypodermoclysis, —- nutrients are delivered through a subcutaneous needle or port; and. E. Nasogastric Tube (NGT)—n utrients are provided into the stomach through the nasal cavity. All these medically-provided nutrition ...
Why do we need a feeding tube?
Even though a feeding tube may be essential for helping you maintain a healthy, active life during and after cancer treatment, it can be a big lifestyle change.
What is the purpose of a feeding tube for cancer patients?
When cancer patients struggle with this, a feeding tube can be a solution. These flexible plastic tubes placed in the stomach can help provide the calories, protein, vitamins, minerals and fluids needed to help the body fight infection, ...
How long does a gastrostomy tube last?
This tube is often used when patients will need to rely on a feeding tube for about three to four months or longer. It’s very easy to use.
What is a J tube?
Jejunostomy tube (J-tube): A J-tube is a soft, plastic tube placed through the skin of the belly into the midsection of the small intestine. It can be placed as an inpatient or outpatient procedure. The tube delivers food and medicine until the person is healthy enough to eat by mouth. It bypasses the stomach completely and is often used when the patient cannot digest food in the stomach, like in some cases of stomach cancer. This tube is also best-suited for long-term use.
Why do cancer patients need feeding tubes?
Cancer patients may need a feeding tube if they: Have trouble swallowing due to cancer in the head or neck area. Are malnourished before or during cancer treatment, including surgery, chemotherapy and radiation therapy. Have fistulas, an opening, or an abscess in the esophagus or stomach.
How do feeding tubes work?
Different tubes work in different ways. Some use a pump – typically formula. Others rely on gravity or a syringe to push the food. Your care team will teach you how to use your specific feeding tube.
Where is the feeding tube placed?
It is placed at the patient’s bedside in the hospital and doesn’t require a surgical procedure.