Temporary and Permanent Placement of Feeding Tubes (2024)

A feeding tube is a medical device used to feed a person who is unable to eat or drink. A person may need a feeding tube due to difficulty swallowing, an eating disorder, or other feeding issues.

Feeding tubes may be needed for a short-term concern or a more permanent basis. Temporary feeding tubes are placed in the nose (nasogastric or NG tube) or through the mouth (orogastric or OG tube).

Permanent feeding tubes are placed through the abdomen to either the stomach (gastric or G tube) or small intestine (jejunostomy or J tube). These tubes are placed using minimally invasive surgery and used for as long as the individual requires enteral nutrition.

This article discusses the different feeding tube types, how they are placed, and why a feeding tube may be needed.

Temporary and Permanent Placement of Feeding Tubes (1)

Purpose of a Feeding Tube

A feeding tube has uses beyond ensuring that someone with dysphagia (who cannot chew or swallow) is fed. The most common uses of a feeding tube include:

Providingnutrition:Food in liquid form can be given through a feeding tube.Tube feeding, or enteral nutrition, allows for needed carbohydrates, protein, and fats to support the body.
Providingfluids: Water given through a feeding tube can keep a person hydrated without needing intravenous IV fluids.
Providingmedication: Needed drugs, including many pills and tablets, can be given through a feeding tube.Their contents can be powdered and blended with water to administer them.
Decompressing the stomach: Some feeding tubes can be used to remove air in the stomach. Suction connected to the tubes can remove gas, reducing distention (enlargement) and bloating.
Removingstomach contents: Undigested food sitting in the stomach can cause nausea, vomiting, stomach pain, and bloating.Suction can be used to remove fluids and food particles.

When a Feeding Tube Is Used

The body does better with food delivered to the gut rather than having artificial nutrition and fluids sent through an IV and into the blood vessels. It is safer and healthier for a person to receive food and fluids in the stomach for normal digestion.

Trouble swallowing can cause a person to choke on food and fluids. They can “go down the wrong pipe” and be inhaled into the lungs through the trachea rather than into the esophagus that leads to the stomach. This can lead to serious illness, including aspiration pneumonia.

Conditions That May Require a Feeding Tube

Feeding tubes can be used for different reasons. They can include short-term uses, such as when illness or injury leaves them unable to swallow safely. Feeding tubes are also used in managing long-term conditions like chronic stomach or digestive disorders, feeding or eating disorders, and end-of-life situations.

Conditions and situations that may warrant a feeding tube include:

Bowel obstruction
Crohn’s disease
Coma
Digestive system injuries
Gastrointestinal cancer
Eating disorders, including anorexia and avoidant restrictive food intake disorder (ARFID)
Esophageal disease
Head and neck cancers
Intestinal failure
Paralysis
Recovery after surgery
Short bowel syndrome
Stroke

How do I Make a Feeding Tube Decision for a Loved One?

Deciding on a feeding tube for a loved one can be challenging. It depends on how your loved one expressed their own wishes about their medical care and your discussions with healthcare providers and family. The decision is easier when you receive a thorough assessment of the benefits and risks for your loved one.

Types of Feeding Tubes

Feeding tubes are used by people of all ages. The specific type of tube will depend on the reason for the feeding tube and how long the person will likely need to use it. Feeding tubes are often described by where they are placed and the type of hardware used.

Types by Placement

Feeding tubes can go through the nose (naso-), mouth (oro-), or abdomen and deliver nutrition directly to the stomach (gastric) or jejunum (jejunostomy), the middle third of the small intestine. Types of feeding tubes include:

G tube: A gastric tube (G tube) offers direct access to the stomach through a surgical cut in the left upper side of your abdomen.This means it bypasses the mouth and throat entirely. It allows for food, fluids, and medication to be given without swallowing.
G-J tube: A gastrojejunal (GJ) tube is a feeding tube that goes into both the stomach and small intestines. The G portion of the tube can be used to vent the stomach and relieve gas pain. Nutrition can be delivered into either the G or J tube.
J tube: A jejunostomy tube (J tube), like the G tube, is placed through an incision in the abdomen. But this cut is placed lower than the G tube so that the tube ends in the middle third of the small intestine, known as the jejunum. It tends to be smaller than the G tube, so only thin liquids and powdered drugs can pass through it.
NG tube: A nasogastric (NG) tube is inserted into the nose and down through the throat. It is threaded into the esophagus and rests in the stomach.It can stay in place for four to six weeks before removing it or replacing it with a long-term feeding tube.

NJ or ND tube: Nasojejunal (NJ) and nasoduodenal (ND) tubes are similar to an NG tube but extend past the stomach into the jejunum or duodenum of the small intestine.
OG tube: An orogastric (OG) tube is similar to an NG tube, but it is inserted into the mouth instead. It then follows the same pathway through the throat and esophagus and into the stomach.It can remain there for up to two weeks before it is removed or replaced.
PEG tube: A G tube placed using the percutaneous endoscopic gastrostomy (PEG) technique is called a PEG tube. A gastroenterologist (a doctor specializing in digestive disorders) will use a lighted instrument called an endoscope to place the G tube through a surgical hole in the stomach. It has a camera attached that allows them to see and confirm this placement.
PEG-J tube: This is a GJ tube placed using the PEG technique.
PEJ tube: A PEJ tube is similar to the PEG tube, except it is placed in the jejunum.
RIG or RIJ tube: Tubes that are placed by an interventional radiologist are referred to as radiologically inserted (RI) tubes. An RIG is a radiologically inserted gastrostomy tube, and an RIJ is a radiologically inserted jejunostomy tube.

Types of Hardware

In addition to where and how the feeding tube is placed, tubes are also described by the type of connection, and feeds are described by the equipment used. These are some feeding-tube terms you may come across:

A button (also called a MIC-KEY or a bard) is a low-profile G tube held in place by a bumper or balloon. Buttons lie flat on the skin and can be opened and closed to allow for feeds. The button is connected to an extension set—a short tube with ports that allow for feeds and can be removed or left connected.
A dangler is a term for the part of a traditional G or J tube that extends out from the abdomen. Danglers, or long tubes, are typically between 2.5 and 4 inches in length. It is anchored inside the stomach or intestines using a bumper or a balloon that is filled with water. The end of the dangler has different-sized ports to put formula or food through.
Gravity feed bags are a way of delivering tube feed. Formula or blended food is placed in the feed bag hung on a hook 2 to 3 feet above you. When you open the clamp, gravity will pull the formula into the tube. Once the air is out of the tube, it is connected to the port until the feed is complete.
Pump feeds are similar to gravity feeds but use a pump to control the flow. Your healthcare provider will let you know how to adjust the rate of the flow so it is comfortable for you. Pump feeds can be delivered at a slow rate for continual feeds or a faster rate for bolus feeds.

Syringe feeds use a syringe to deliver formula or blended food. Syringe feeds can be pushed through the tube using the plunger or with the plunger removed and held above, similar to a gravity feed.

How Feeding Tubes Are Placed

The way in which a feeding tube is placed depends on the type of tube. Temporary feeding tubes can be placed either bedside or in the operating room. Permanent feeding tubes will require surgery.

Placing Temporary Tubes

An NG tube can be placed while the person is awake. The tube is lubricated, inserted into the nostril, and guided down the esophagus into the stomach. The healthcare provider will then check to make sure the tube is placed in the stomach.

An OG tube is typically placed under anesthesia. Once the person is sedated, a gastric tube guide—a wider, curved tube—is placed in the mouth and down the throat. The feeding tube is threaded through the tube guide until it reaches the stomach.

Placing Permanent Tubes

G tubes, J tubes, or G-J tubes are placed surgically, using an endoscope, under anesthesia. The endoscope has a camera that transmits pictures to a computer monitor in the operating room, which allows the surgeon to see inside the body.

For a G tube, the endoscope is threaded from the mouth into the stomach. The healthcare provider can see the endoscope’s lighted tip, showing them where to make a small incision on the abdomen. The incision, about 1/2-inch long, is known as a stoma. The G tube is then passed through it and secured in place.

J tube placement follows the same procedure, except the endoscope is threaded to the jejunum, where the incision is made. A J tube sits lower on the abdomen than the G tube.

A G-J tube is placed similarly to a G tube, with one incision over the stomach. A G-J tube has multiple ports. The J port is connected to a tube that extends into the jejunum, while the G port goes to the stomach.

For G, J, and G-J tubes, the surgeon will place either a dangler tube or a button. Buttons are more commonly used for G tubes, while danglers are more common for J and G-J tubes. In some cases, a dangler will be placed initially and then replaced with a button after the stoma heals.

A feeding tube placement procedure takes 30 to 45 minutes and usually requires an overnight hospital stay. The abdomen will be sore for a few weeks following tube placement until the stoma heals.

Permanent feeding tubes will need to be changed periodically. Buttons changes are typically recommended every three to six months. Danglers need to be changed less frequently and are commonly recommended every 12 months.

How Feeding Tubes Are Removed

The procedures for removal depend on whether it is a temporary or permanent feeding tube.

Temporary Feeding Tube Removal

It’s a simple and quick procedure to remove a temporary feeding tube. Any irritation to the mouth, throat, and nose is typically minimal.

A syringe is used to empty the tube of food and fluids. It then takes a matter of seconds to withdraw the tube and verify it has been done safely.

Permanent Feeding Tube Removal

Some people may recover enough ability to eat and drink well, even though their tube is considered permanent. The decision to do so is usually based on whether you’ve maintained your weight for a month while still on a feeding tube, though some healthcare providers may want more time.

The withdrawal process is similar to a tube change, without replacing the tube. In some cases, stitches may be used to close the stoma, though sometimes the stoma is left to heal on its own, which takes one to two weeks.

The stoma will leak until it heals completely. Keep the area covered to protect clothing and bedding. Change the dressing frequently and wash the skin with gentle soap and water to prevent irritation. Do not submerge the stoma underwater until it is fully closed. Once the stoma stops leaking, you no longer need to keep it covered.

Summary

Feeding tubes are used to ensure that someone unable to swallow can still get needed nutrients, fluids, and medication. The need for the tube might be temporary or permanent due to a chronic condition.

The kind of tube will depend on the condition and how long it’s needed. Short-term tubes, like the NG and OG, should come out in a few weeks. Long-term tubes, like the G tube or J tube, are meant to stay—although in some cases, they may one day be removed too.

Both the placement and removal procedures for these tubes are pretty straightforward, although there are some minor effects that typically follow the removal of a tube meant for long-term use.