Maintaining adequate nutrition is an important part of cystic fibrosis (CF) treatment. Much of the time, nutritional needs can be met by following the diet plan prescribed by your CF team. Sometimes, no matter how closely you stick to the plan, you will not be able to consume enough calories or nutrients to meet your body’s high requirements. When this happens, your healthcare provider may recommend giving your body a nutrition boost through supplemental tube feedings.
Is it Time For Tube Feedings?
Tube feedings, also called enteral feedings, may be a part of your CF treatment on and off throughout your life. There are many scenarios that could lead to tube feedings being included in your treatment plan. For example, you may be struggling with an infection that makes it difficult for you to eat, or increases your work of breathing so much that you can’t eat enough to meet your energy requirements. Or, you may be eating well but still not growing or maintaining weight like you should.
During your routine clinic visits, your healthcare provider closely monitors your weight and growth patterns. If you begin to show signs that you are not getting adequate nutrition through diet, your provider may recommend tube feedings. Some of the signs that may indicate the need for tube feedings are:
- Weight for height less than 85%
- Weight loss for 2 consecutive months
- No weight gain for 2 to 3 months in children under age 5
- No weight gain for 6 months in children age 5 and over
Types of Feeding Tubes
There are two main types of feeding tubes – one type is inserted through your nose and the other through your abdomen. Your healthcare provider will decide which type of tube to use based on your unique needs and situation.
Nasogastric Tube (NG Tube): A nasogastric tube is a thin, flexible tube that goes in your nose, down your throat, and into your stomach. Your doctor may recommend an NG tube if tube feedings will only be needed for a few days, or possibly up to a few weeks. This is the least invasive type of feeding tube because inserting an NG tube does not require a surgical incision. Unfortunately, NG tubes are easily dislodged and can cause discomfort in the nose and throat, so they are not the best choice for long-term treatment.
Gastrostomy Tube (G-tube): A gastrostomy tube, also called a G-tube or a PEG tube, is a flexible tube that is inserted directly into the stomach through an incision in the abdomen. G-tubes are suitable for long-term use, so your doctor will probably recommend this type of tube if he thinks you will need supplemental nutrition -- either continuously or intermittently -- for more than a few weeks.
Jejunostomy Tube (J-tube): A jejunostomy tube, also called a J-tube, is the same as a G-tube except it bypasses the stomach. J-tubes are inserted through an incision in the abdomen directly into the section of the small intestine called the jejunum. J-tubes are used when a person cannot tolerate feedings directly into the stomach.
Gastrostomy-Jejunostomy Tube (GJ-Tube): A Gastrostomy-Jejunostomy tube, also called a GJ-tube, is a tube that is inserted through the abdomen into the stomach, but does not stop there. The GJ-tube passes through the stomach into the jejunum, delivering the feedings directly into the small intestine just as they are with a J-tube. GJ-tubes are often used when a person who already has a G-tube is no longer able to tolerate feedings in the stomach. Rather than making a new incision in the abdomen, a longer tube is threaded through the existing opening into the jejunum.
Tube Feeding Formulas
There are many brands of tube feeding formulas available. Your doctor or nutritionist will prescribe the formula that contains the right amount of calories and nutrients for you. Usually, tube feedings are given as supplements, meaning you will still eat regular foods in addition to the tube feedings. In instances when you cannot tolerate food by mouth, such as if you are having severe breathing difficulties that prevent you from swallowing safely, tube feedings can supply all of your nutrition until you are able to eat again.
Depending on your needs and which type of tube you have, your feedings will either be given through a pump that delivers the formula slowly over a period of several hours, or a syringe that allows the formula to drip in over a few minutes.
Conway S, Morton A, Wolfe S. Enteral Tube Feeding for Cystic Fibrosis. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001198. DOI: 10.1002/14651858.CD001198.pub2
Tan, J and Ng, M. Enteral Nutrition. SFP ; 34(4): 70-76