The Procedure

Before tube feeding can begin, the tube has to be placed. The procedure for the feeding tube placement depends on the type of tube that has been recommended by the healthcare team. You can find more information about the types of feeding tubes here.

Nasogastric (NG) and nasojejunal (NJ) tubes do not require surgery for placement and are most often used for shorter term tube feeding. These tubes are more visible than a gastrostomy or a jejunostomy and their placement may cause some discomfort.

The NG tube is placed through the nose, down the oesophagus and into the stomach, whereas the NJ tube is placed through the nose, down the oesophagus, through the stomach and into the small intestine (jejunum). On occasion, the NJ tube may be placed using x-rays.

The position of the NG and NJ tube must be confirmed before tube feeding can commence.

After the insertion/placement of the tube

After the NG or NJ tube insertion you will be given advice by the healthcare team and they will explain how long you or the person you care for might have to stay in hospital.

Starting feeding varies greatly, however you will be kept informed by the healthcare team. You or the person you care for will be discharged home when feeding is established and well tolerated. This usually depends on the condition and confidence with the tube feeding process. It is important to follow the advice that was given by the healthcare team.

Gastrostomy and jejunostomy tubes require a procedure or surgery for placement where a stoma site is formed.

1. Endoscopy: The gastrostomy tube can be inserted using an endoscope. This feeding tube is called a percutaneous endoscopic gastrostomy (PEG). An endoscope is a long narrow tube with a camera and light at the end of it. It is passed through the mouth and throat, down the oesophagus and into the stomach (PEG) or small intestine (PEG-J). The surgeon will use the endoscope to place the feeding tube in the stomach and secure it in place.

2. Radiology guided: The gastrostomy tube can be inserted using x-rays to place the feeding tube into the stomach. This is called a radiologically inserted gastrostomy (RIG).

3. Surgically: The gastrostomy or jejunostomy tubes can also be placed surgically. The surgeon will make an opening into the stomach or small intestine (jejunum) and place the feeding tube through the skin into the stomach or jejunum. The stoma site in the stomach/jejunum is then stitched closed around the tube.

Before the operation or procedure

The healthcare team will discuss and explain the procedure and ask you to sign a consent form. If the procedure/operation is under a general anaesthetic, another doctor (the anaesthetist) may visit to explain about the anaesthetic used to ensure you or the person you care for remains asleep during the procedure. Blood samples may be taken to check if you're well enough before the operation.

The healthcare team will advise you on the estimated length of stay and post-operative feeding regime for you or the person you care for's individual circumstances. Not all the procedure mentioned above require a general anaesthetic.

After the operation or procedure

After the procedure you will be given advice by the healthcare team and they will explain how long you or the person you care for might have to stay in hospital.

The site of the gastrostomy/jejunostomy may look a little red and ooze a bit, but this will settle down a few days after the operation. You or the person you care for may take mild pain killers to control the pain, as advised by the healthcare team. When the healthcare team is satisfied with the progress made, feeding will start through the new tube for the first time.

The time from procedure to first feeding can vary, however you will be kept informed by the healthcare team and the dietitian. You or the person you care about will be discharged home when feeding is established and well tolerated. This usually takes three to five days, but may be longer depending on the individual condition and confidence with the tube feeding process. If the feeding tube has an external fixator, it is important to follow the advice that was given by the healthcare team.

Please seek urgent medical attention if you or the person you care for are experiencing any of the following symptoms within the first three days following your procedure:

• Pain on feeding
• Prolonged or severe pain
• Fresh bleeding
• Leakage from the stoma site.

Glossary

Stoma site = an opening from the outside of the body through the skin where the feeding tube enters into the stomach or the small intestine (jejunum).

Endoscope = a slender tube used to examine the inner part of the body with an attached instrument for biopsy or surgery.

General anaesthetic = medications used to cause a loss of consciousness so a patient is unaware of surgery. Given by an anaesthetist (a specially trained doctor), it will either be given as a liquid that's injected into the veins or a gas that you breathe in through a mask.