Types of Feeding Tubes
Whether you're preparing to get a tube, to visit someone who you've heard has a tube or need to learn all the types before professional placements starts tomorrow, here's a quick, concise guide!
To ridiculously oversimplify things, lean these 3 now:
NG & PEG
NJ, J-tube
IV line.
Well done!
To be more comprehensive,
The types are:
NG
ND/NI/NJ
PEG/RIG/G-Tube
GJ/PEG-J
PEJ/J-Tube
Then, some intravenous lines can be used for specialised intravenous nutrition:
PICC
Hickman
It's not actually as complicated as it looks, I promise!
Basically:
Nose to stomach or intestine
Or
Hole into stomach or intestine
Or
Veins
Enteral feeding tubes are ones which go into the digestive tract either through the nose or directly through the skin.
Think ENTER as in gastroENTERology
Sometimes, people need parenteral nutrition. This means bypassing the enteral. Parenteral goes straight into veins. That's PAR-enteral, not parental hehe ;) It's often called TPN for short (Total Parenteral Nutrition), especially if the person is dependent on it. Occasionally the term HPN is used if the person uses it at home. The H is for "home"
Ok. Back to Enteral tubes:
Nasoenteric Tubes (any feeding tubes that go in by the nose):
NG = nasogastric. Goes through nose into stomach. Quite common.
ND = nasoduodenal. Through the nose and stomach into the 1st part of the small intestine called the duodenum. Rare because nasojejunal is typically seen as preferable. Some NJs technically end up in the duodenum but may still be simply referred to as an NJ. My NJ often lands right at the juncture where the duodenum becomes the jejunum.
NJ = Nasojejunal. Through the nose , via stomach and duodenum into the second part of the small intestine called the jejunum.
NI = Nasointestinal. Sometimes this word might be used to include NDs and NJs on a product packet or in a medical paper. Nasoenteric may be a term used too
In essence, NG or NJ
Percutaneous (through-the-skin) Enteral Feeding Tubes:
PEG: Percutaneous Endoscopic Gastrostomy tube. Common.
RIG = Radiologically Inserted Gastrostomy. Often these simply get called PEGs anyway.
G-tube = Another word for either PEG or RIG.
PEG-J = PEG with extension tube inside to the Jejunum.
GJ = Gastrojejunostomy. Basically a PEG-J but doesn't necessarily have "percutaneous endoscopic" insertion. It could be radiologically inserted.
J-Tube = Goes directly through a hole made in the skin into the jejunum.
PEJ = A J-tube placed using endoscopy. Like RIGs, sometimes people still call radiologically inserted jejunostomies "PEJ".
So, G, GJ or J
Any feeding or placement into the intestine may also be called "postpyloric", especially in medical academic journals. This means anywhere beyond the stomach. The pylorus is the far part of the stomach before intestine.
BONUS/SIDE NOTE: Most feeding tubes are "single lumen" (lumen = inside channel) but double, even triple lumen tubes exist. Extra channels might be for extra hydration, medicines or "venting" stuff OUT such as painful excess stomach air. Usually medicines and extra water are done through ordinary single lumen tubes and a separate tube is often used if venting is necessary.
Now the Parenteral ones:
These are intravenous lines rather than what's typically classified as a "feeding tube".
PICC = Peripherally Inserted Central Catheter. This is the more common of the parenteral line types and usually short term. It goes into the upper arm. Inside the body the line goes through a vein into the chest, to the heart. Peripheral = opposite of central, so further/outer. (Catheter = tube that goes inside a body channel eg vein, urethra etc)
Hickman Line: This delivers nutrition pretty much the same way but goes in by the chest.
There are other IV line types but usually for medication or hydration rather than feeding. PICCs and Hickmans are often are used for medications too.
Why use gastric enteral feeding (NG, PEG etc)?
Can't or won't eat enough to meet nutritional needs.
Why Postpyloric/intestinal feeding (NJ, GJ, J-tube etc)?
As above but feeding into stomach is ineffective, unhelpful, intolerable or perhaps dangerous.
Why Parenteral (PICC etc)
Last resort if nothing else gives the necessary nutrition and/or balance.
Or if the person is "nil by mouth" but must get the nutrition
Occasionally, people have more than one type.
For example: someone might depend on a line in the veins but spend part of the day on a Nasojejunal feeding as much as they can tolerate, and have an old PEG site used for a tube for venting.
Another example: PEG fed and using PICC every so often to make up for some kind of deficiency.
So you've got the gist of it!
If you have any questions or if I've made any mistakes, feel free to let me know as long as it's nicely! :-)
Now for a pronunciation guide for anyone who needs it:
Nasogastric = NAY-zo-GASS-trick
Duodenum = DYOO-oh-DEE-num. Some might say dyoo-ODD-en-um
Jejunum = JEJ-oo-num or jej-OO-num
Percutaneous = PER-cyu-TAY-nee-us
Endoscopic = END-oh-SCOPP-ic
Gastrostomy = ga-STROSS-tum-ee
Jejunostomy = JEJ-ooNOSS-tum-ee
Parenteral = parENT-er-al
Radiologically = RAY-dee-ol-LOJ-ic-al-ee
Postpyloric = POST-pie-LOR-ic
Intravenous = IN-tra--VEE-nus
Peripherally = per-IF-er-al-ly