You can have liquid food in different ways.
There are 2 types of liquid feedings:
- enteral nutrition when you have food directly into the stomach or small bowel
- parenteral nutrition when you have food directly into a vein (PN)
Having food directly into the stomach or small bowel
Having a feed through a tube into your stomach or small bowel (intestine) is called enteral nutrition.
Enteral nutrition uses specially prepared liquid feeds. Different mixtures (formulas) are available. Your dietitian chooses the most appropriate one for you. This depends on your own particular nutritional needs.
You might need to take all your food and drink this way. Or you may take some food by eating normally, and then have the rest as a liquid through the tube.
Enteral feeding is only for people whose stomach and intestines work as usual. This is because the feeds still go through the usual path of digestion.
You can't have enteral feeding if you have:
- a blockage in the bowel
- severe diarrhoea or sickness
You might need enteral feeding when:
- you have swallowing problems
- there is a risk that food and fluid can go down the wrong way
The feeds are concentrated. They can sometimes cause bloating and diarrhoea. You might need to have your feeds at a slower rate if this happens. It is common to start slowly and then build up the amount gradually. Your dietitian might also change the type of feeding you are having.
You may need extra fluids through a drip to prevent dehydration if you have diarrhoea.
Different types of tubes
Several types of tubes are used for enteral feeding:
A nasogastric tube is a thin tube that goes in through your nose and down your throat into your stomach. You might have this if you need feeding for 2 to 4 weeks.
A nurse or a doctor puts the tube in. It is not pleasant but is a quick procedure.
Some people might have a nasojejunal tube (NJT).
An NJT is like a nasogastric tube, but the tip goes into the second part of the small bowel (the jejunum).
Your doctor might suggest an NJT:
- when your stomach cannot empty properly
- to get past a blockage in the small bowel
- after pancreatic surgery
You might have this type of tube if you have had stomach or food pipe (oesophageal) surgery.
These tubes go into a part of the small bowel called the jejunum. The jejunum is situated a little way after the stomach.
To put a PEJ tube in you have an endoscopy. That means the surgeon puts a tube with a camera on the end through your mouth. The tube goes down your food pipe and into your stomach. This way, they can see where to place the PEJ tube. The surgeon then puts the jejunostomy tube through an opening in the tummy (abdomen) and into your jejunum. You have sedation for this procedure.
With a PEJ tube, you usually have feeds at a slow rate. You have a pump that controls the speed of the feed passing into the tube.
Some people might have a RIG tube. It is a gastrostomy tube. Your doctor puts it directly into your stomach under x-ray guidance.
You have it under local anaesthetic. It is for people who can't have an endoscopy. This might be because of a tumour in the food pipe (oesophagus).
You might have a PEG tube if you have long term problems with eating and swallowing. For example, with cancer of the head and neck or cancer of the food pipe (oesophagus).
A PEG tube goes into your stomach through an opening made on the outside of your tummy (abdomen).
To put a PEG tube in, you have an endoscopy. That means the surgeon puts a tube with a camera on the end through your mouth. The tube goes down your food pipe and into your stomach. This way, they can see where to place the PEG tube. The surgeon then puts the tube through an opening in the tummy (abdomen) and into your stomach. You have sedation for this procedure.
The feeds usually run for most of the day through a pump. You have 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 have feeds at home, your dietitian will guide you about how much feed you need and the timings.
Having food directly into a vein
Parenteral nutrition (PN) is when you have a feed into your bloodstream through a drip into a vein.
With parenteral nutrition (PN) 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 a major blood vessel, as this diagram shows:
How it works
The end of the line hangs out of the chest.
When it is not in use, a cap seals the central line. When you have your feed, a nurse removes the cap and connects the line to the drip containing your PN.
When all the feed has gone through, the nurse flushes the line. This is with either sterile salt water or an anti clotting solution. The nurse then seals the line again.
You usually have the line put in under local or general anaesthetic. A specially trained nurse or doctor does this procedure. There can be complications. Sometimes lines get infected or blocked and have to be taken out and replaced.
When you might need it
You are only likely to need PN feeding when your gut is not working. For example, if you:
- have severe sickness
- have severe problems with your stomach or small bowel (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
About PN feeds
The feeds used for PN are very complex. They are carefully made up in a sterile room each day by a pharmacist.
Doctors and dietitians tell the pharmacist about your specific nutritional needs each day. They will check you regularly while you have PN. You will need frequent blood tests to check that your blood is normal. These include your levels of minerals, sugar, salts and other substances.
PN can have side effects. These include a high blood sugar level, or they may affect the way your liver works.
Your doctor gradually reduces your PN feeds when it is time for you to stop having them.
Tube feeding at home
You might need to go on using these methods of feeding after you leave the hospital. This may feel frightening at first, but most people get used to it. Try not to worry about it. You will have support.
Your nurses will show you and your carers how to run the feeds before you leave the hospital. Most people have daily visits from a district nurse at first. These go on for as long as you need them. And your nurses give you the telephone numbers of people to contact if you need help.
You will also have regular follow up appointments to check on how you are getting on.