Drip or tube feeding
This page tells you about tube feeding for people with cancer. There is information about
Sometimes people with cancer need to have food through a tube going into a vein or into their stomach or bowel. Tube feeding is used to give nutrition to people who need to put on weight or maintain their weight and who can't eat or absorb food normally. It may be used for people who
- Can't absorb nutrients very well from their gut
- Are very run down and severely malnourished before surgery
- Are malnourished before starting chemotherapy or radiotherapy
- Have problems with swallowing due to a cancer in the head or neck area
- Have holes (fistulas) or an abscess in the oesophagus or stomach
- Can't eat or drink for 5 days or more after an operation or other types of treatment
- Have a severely sore mouth or throat after a bone marrow transplant
If you are severely malnourished before a major operation, you may benefit from tube feeding. Your doctor is most likely to suggest extra high calorie drinks from 8 to 10 days before your operation. But they may suggest you have feeds through a tube into your stomach. If you can build yourself up a bit before your operation, it will help you to recover afterwards. You may not gain weight but your overall health will improve. This helps you heal faster and cope with the demands of a big operation.
In very particular situations, you may benefit from a tube feed into your stomach or bowel before a course of chemotherapy or radiotherapy. It could help you put on weight and may improve your general health, although there is no evidence that it makes cancer treatment work any better. People with head and neck cancers are most likely to benefit. They are often malnourished and have problems swallowing before they begin treatment.
So far there is no real evidence that these feeding methods reverse malnutrition and cachexia if you have advanced cancer. But they may help you feel better. We have more information about managing diet problems in advanced cancer.
This used to be called ‘total parenteral nutrition’ (TPN) but now it is often just called ‘parenteral nutrition’ (PN). This means being fed directly into your bloodstream through a drip into a vein. The feeds don't go through your normal digestive system. You have PN through a central line or a PICC line. A PICC line goes up a blood vessel in your arm and into a chest vein. Other types of central lines go into the chest and directly into a major blood vessel, as this diagram shows
The end of the line hangs out of the chest. If not being used, the central line is sealed off with a cap. When it is time for your feeds the cap is taken off and the line is connected to the drip containing your PN. When all the feed has gone through, the line is flushed out with sterile salt water or an anticlotting solution and then sealed off again.
This procedure is done by a specially trained nurse or doctor. You usually have the line put in under local anaesthetic in out patients. There can be complications. Sometimes lines get infected or blocked and have to be taken out and replaced.
You are only likely to need PN feeding in circumstances when your gut is not working. For example, if you
- Have severe sickness
- Have severe problems with your stomach or intestine, or if they have been removed
- Have severe nutritional problems before surgery and can't have enteral feeding
- Have a hole (fistula) in your stomach or oesophagus
- Are losing a lot of weight or not coping well with enteral feeding
The feeds used for PN are very complex and are carefully made up in a sterile room each day by a pharmacist. Doctors and dieticians advise the pharmacist about your specific nutritional needs each day. They monitor you very closely while you are having PN. You will need frequent blood tests to check that your blood levels of potassium, sugar, sodium and other substances are normal. PN can have side effects, such as causing a high blood sugar level or affecting the way your liver works. When it is time for you to stop having PN feeds, your doctors will very gradually reduce them over a few days.
This is called 'enteral nutrition' and means being fed with specially prepared liquid feeds through a tube into your stomach or small intestine. Different formulas are available. Your dietician will choose the most appropriate one for you, depending on your own particular nutritional needs. Some people may need to take all their food and drink this way. But other people may take some food by eating normally and the rest as liquid through the tube.
Enteral feeding is only suitable for people whose digestive tract (stomach and intestines) is working normally. This is because the feeds still go through the usual path of digestion. It is not suitable if you have
Enteral feeds can cause side effects. Because they are quite concentrated, some of the feeds can cause a bloated feeling and diarrhoea. If this happens, you may need to have your feeds more slowly. It is common to start off slowly and then build up the amount gradually. You may also need extra fluids through a drip to prevent dehydration if you have diarrhoea. There are several types of tubes for enteral feeding, including
- Nasogastric tubes (NGT)
- Percutaneous endoscopic gastrostomy tubes (PEG tube)
- Radiologically inserted gastrostomy tube (RIG)
- Percutaneous endoscopic jejunostomy tube (PEJ tube)
A nasogastric tube is a thin tube that is put into your nose and down your throat into your stomach. This is normally put in by a nurse or a doctor. It is not pleasant but is a quick procedure. It is usually used if you need feeding for less than 3 weeks. A nasojejunal tube (NJT) may also be used. An NJT is like a nasogastric tube but the tip goes into the first part of the bowel (the jejunum). NJTs are used
- When the stomach cannot empty properly
- To get past a blockage in the small bowel
- After pancreatic surgery
A percutaneous endoscopic gastrostomy tube (PEG tube) goes into your stomach through an opening made on the outside of your abdomen. This procudure is done under sedation. To put a PEG tube in you have an endoscopy. This means the doctor puts a tube with a camera on the end through your mouth, down your food pipe and into your stomach. They can then see where to place the PEG tube, which is put in through the skin of your abdomen. This type of tube is used for people who have long term problems with eating and swallowing - for example, with cancer of the head and neck or cancer of the oesophagus. The feeds usually run for most of the day through a pump, with a break of a few hours to give the stomach a rest. But sometimes feeds can go in over 24 hours at a low rate. If you are having feeds at home, your dietician will guide you about how much feed you need and the timings.
These tubes are gastrostomy tubes which are put directly into the stomach under X-ray guidance. This is done under local anaesthetic. It is done for people who can't have an endoscopy, perhaps because because of a tumour in the oesophagus.
These tubes are put into a part of the small intestine called the jejunum. The jejunum is situated a little way after the stomach. The surgeon puts a tube through an opening in the abdomen and into your jejunum. PEJ tubes are put in using an endoscopy, like a PEG tube. This type of tube is particularly used for people who have stomach or oesophageal surgery. If the tube goes directly into your small intestine, you usually have feeds slowly all the time. You have a pump that controls the speed of the feed passing into the tube.
Some people may need to go on using these methods of feeding after they leave hospital. This may seem very scary at first but people usually get the hang of it quite quickly. So try not to worry too much about it. Your nurses will show you and your carers how to run the feeds before you leave hospital. Most people have daily visits from a district nurse at first and these will go on for as long as you need them. Your doctors will monitor you closely at regular follow up appointments. And your nurses will give you the telephone numbers of people to contact for help if you need it.
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