What are the different types of nutrition tube feeds and their indications?

From the Guidelines

The most appropriate type of nutrition tube feed and its indication should be determined based on the patient's medical condition, digestive capacity, and specific nutritional requirements, with consideration of the latest evidence from the 2023 consensus guidelines for perioperative care for emergency laparotomy enhanced recovery after surgery (ERAS) society recommendations 1.

Types of Nutrition Tube Feeds

• Polymeric (standard) formulas, which contain intact proteins and are suitable for most patients with normal digestion
• Elemental or semi-elemental formulas, which provide pre-digested nutrients (peptides, amino acids) for patients with impaired digestion or absorption
• Disease-specific formulas tailored for conditions like diabetes, renal failure, or respiratory failure
• Immune-enhancing formulas containing additional nutrients like arginine, glutamine, omega-3 fatty acids, and nucleotides for critically ill or post-surgical patients
• Specialized formulas, including high-protein options for wound healing and catabolic states, fiber-enriched formulas to promote bowel regularity, and concentrated formulas for fluid-restricted patients

Indications for Nutrition Tube Feeds

• Patients who cannot meet their nutritional needs orally but have functioning gastrointestinal tracts
• Patients with swallowing difficulties, such as those with stroke or head injury, who require early nutrition via PEG or nasogastric tube feeding 1
• Patients who are anticipated to have swallowing difficulties for more than seven days and therefore not reach a sufficient oral intake
• Patients with miscellaneous diseases who have swallowing difficulties, such as those with nasogastric tube feeding, who may require PEG tube feeding 1

Administration of Nutrition Tube Feeds

• Tube feeds are typically administered via nasogastric, nasoduodenal, nasojejunal tubes for short-term use
• Via gastrostomy (PEG) or jejunostomy tubes for long-term nutritional support
• Early tube feeding (within 24 h) should be initiated in patients in whom early oral nutrition cannot be started, and in whom oral intake will be inadequate (< 50% of caloric requirement) for more than 7 days 1

Key Considerations

• The selection of the appropriate formula depends on the patient's specific needs, with consideration of caloric density, protein content, and micronutrient profile to ensure optimal nutritional support
• The risk of internal pressure sores, small diameter nasogastric feeding tubes (8 French) should be used in stroke patients, and tubes with a greater diameter should only be placed if gastric decompression is necessary 1
• Dysphagia therapy should start as early as possible, in tube-fed as well as non-tube-fed patients, and the correct position of the nasogastric tube should be controlled before the application of tube feed 1

From the Research

Types of Nutrition Tube Feeds

• Nasogastric tube feeds: used for patients who can eat but require forced nutritional support 2
• Nasoenteral tube feeds: used for patients who require more direct access to the small intestine 2
• Gastroenterostomy tube feeds: used for patients who require long-term nutritional support 2
• Fine-bore tubes: easily misplaced or dislodged, require careful monitoring 3

Indications for Nutrition Tube Feeds

• Inability to ingest sufficient nutrients by mouth in the presence of a functioning gastrointestinal tract 4
• Malnutrition in patients with cancer, particularly those receiving radiation to the head and neck, those with persistent dysphagia, and critically ill patients with impaired gastric emptying 5
• Patients who require enteral nutrition support following a gastrectomy or esophagectomy or have impaired gastric emptying 5

Considerations for Nutrition Tube Feeds

• Selection of the appropriate tube and formula to minimize the risk of medical complications 2, 3
• Proper positioning of the tube to prevent aspiration and other complications 2, 3
• Monitoring of patients for gastrointestinal, mechanical, and metabolic complications 3, 6
• Ongoing nutritional assessments to ensure the overall adequacy of the enteral feeding in restoring or maintaining nutrition 3