What are the two main types of feeding tubes?

That you are a healthcare professional and are following the appropriate guidance in your country.

The content in this section is only intended for healthcare professionals.

A feeding tube is a medical device used to feed a person who is unable to eat or drink. A person may need a feeding tube due to difficulty swallowing, an eating disorder, or other feeding issues.

Feeding tubes can be temporary and placed in the nose (nasogastric or NG tube) or through the mouth (orogastric or OG tube).

People who require long-term nutritional assistance may get a permanent tube placed in the stomach (gastric or G tube) or small intestine (jejunostomy or J tube). G tubes are commonly placed using a minimally invasive surgical technique known as percutaneous endoscopic gastrostomy (PEG). They are sometimes called a PEG tube.

This article discusses the different feeding tube types, how they are placed, and why a feeding tube may be needed.

A feeding tube has uses beyond ensuring that someone with dysphagia (who cannot chew or swallow) is fed. The most common uses of a feeding tube include:

• Providing nutrition: Food, in liquid form, can be given through a feeding tube. Tube feeding, or enteral nutrition, allows for needed carbohydrates, protein, and fats to support the body.
• Providing fluids: Water given through a feeding tube can keep a person hydrated without needing intravenous IV fluids.
• Providing medication: Needed drugs, including many pills and tablets, can be given through a feeding tube. Their contents can be powdered and blended with water to administer them.
• Decompressing the stomach: Some feeding tubes can be used to remove air in the stomach. Suction connected to the tubes can remove gas, reducing distention (enlargement) and bloating.
• Removing stomach contents: Undigested food sitting in the stomach can cause nausea, vomiting, stomach pain, and bloating. Suction can be used to remove fluids and food particles.

The body does better with food delivered to the gut rather than having artificial nutrition and fluids sent through an IV and into the blood vessels. It is safer and healthier for a person to receive food and fluids in the stomach for normal digestion.

Trouble swallowing can cause a person to choke on food and fluids. They can “go down the wrong pipe” and be inhaled into the lungs through the trachea rather than into the esophagus that leads to the stomach. This can lead to serious illness, including aspiration pneumonia.

Some people may be too sick to swallow. They may need a ventilator to keep them breathing, which is an endotracheal tube placed in the airway that keeps them from swallowing. Even fully alert people may lose the ability to swallow. A disease like oral cancer may make a feeding tube necessary.

The decision to place a feeding tube is based on more than medical factors alone. It is more complicated when the person's medication or illness leaves them unable to voice their wishes.

They also may not have previously shared these wishes with you and a healthcare team or left you with advance directives that explain the types of care they want in situations like this. This may leave families and healthcare providers instead to discuss the choice on a loved one's behalf.

Sometimes, a decision about placing a feeding tube means two decisions. That's because a feeding tube is often placed at the same time a tracheostomy is done. This hole in the throat allows for long-term use of a ventilator to support breathing after initial intubation in the trachea.

The type of feeding tube used will depend on what's causing the problem. Some are intended to be temporary and can only be used safely for about 14 days. If they are used longer, there is a risk of permanent damage to the larynx (voice box) and tissues in the throat or esophagus.

Others are meant to be long-term or even permanent. They can be used for months or even years across a lifetime. They can be removed as needed but don't result in the same complications.

Nasogastric (NG) tube: This type of tube is inserted into the nose and down through the throat. It is threaded into the esophagus and rests in the stomach. It can stay in place for four to six weeks before removing it or replacing it with a long-term feeding tube.

Orogastric (OG) tube: This is the same type of tube as the NG tube, but it is inserted into the mouth instead. It then follows the same pathway through the throat and esophagus and into the stomach. It can remain there for up to two weeks before it is removed or replaced.

Gastric tube (G tube): The G tube offers direct access to the stomach through a surgical cut in the left upper side of your abdomen. This means it bypasses the mouth and throat entirely. It allows for food, fluids, and medication to be given without swallowing.

Jejunostomy tube (J tube): Like the G tube, the J tube is placed through an incision in the abdomen. But this cut is placed lower than the G tube so that the tube ends in the middle third of the small intestine, known as the jejunum. It tends to be smaller than the G tube, so only thin liquids and powdered drugs can pass through it.

Temporary feeding tubes work the same way, with tubes that end in either the stomach (G tubes) or in the small intestine (J tubes).

Some G tubes are placed using the percutaneous endoscopic gastrostomy (PEG) technique. This means that a gastroenterologist (a doctor specializing in digestive disorders) will use a lighted instrument called an endoscope to place the G tube through a surgical hole in the stomach. It has a camera attached that allows them to see and confirm this placement.

It doesn't take long to place a feeding tube. Anesthesia is required for some people who would otherwise be conscious during the procedure, but that's often not the case for very ill patients who are sedated and need intensive care.

The endoscope is threaded from the mouth into the stomach. The healthcare provider can see the endoscope's lighted tip, showing them where to make a small incision. This is about a half-inch long. Then the G tube is passed through it and secured in place.

A cap on the tube can be opened to administer food and fluids directly into the stomach. With good tube care, the incision will close tightly around the tube and prevent leaks in just a few days' time.

If the skin is irritated by leaking fluid, an ointment can help to protect it. Washing the site with soap and water will usually be all the care it needs.

The procedures for removal depend on whether it is a temporary or permanent feeding tube.

It's a simple and quick procedure to remove a temporary feeding tube. Any irritation to the mouth, throat, and nose is typically minimal.

A syringe is used to empty the tube of food and fluids. It then takes a matter of seconds to withdraw the tube and verify it has been done safely.

Some people may recover enough ability to eat and drink well, even though their tube is considered permanent. The decision to do so is usually based on whether you've maintained your weight for a month while still on a feeding tube, though some healthcare providers may want more time.

The withdrawal process is similar to the temporary tubes, but it requires more force. It also may cause more pain, and small amounts of blood are not uncommon. These issues resolve quickly.

The incision used to place the tube will usually close within a week of its removal.

Feeding tubes are used to ensure that someone unable to swallow can still get needed nutrients, fluids, and medication. The need for the tube might be temporary or related to a chronic condition like stroke or cancer.

The kind of tube will depend on the condition and how long it's needed. Short-term tubes, like the NG and OG, should come out in a few weeks, or they will begin to cause permanent damage. Long-term tubes, like the G tube or J tube, are meant to stay—although in some cases, they may one day be removed too.

Both the placement and removal procedures for these tubes are pretty straightforward, although there are some minor effects that typically follow the removal of a tube meant for long-term use.

The decision to use a feeding tube is based on your or a loved one's wishes. One way to ensure these wishes are known—and kept—is to discuss them in advance and write them down. Healthcare providers and legal advisors can help.

Frequently Asked Questions

• Why would someone need a feeding tube?

  There are a few reasons why someone may need a feeding tube. They can include short-term uses, such as when illness or injury leaves them unable to swallow safely. Feeding tubes are also used in managing long-term conditions like cancer, chronic stomach or digestive disorders, feeding or eating disorders, and end-of-life situations.

• Why are there different types of feeding tubes?

  Some feeding tubes, like the orogastric (OG) and nasogastric (NG) tubes, are intended only for short-term use. They can start to cause tissue damage in as little as two weeks. Other tubes, such as the G and J tubes, can be used longer—or permanently.

• How do I make a feeding tube decision for a loved one?

  This can be so hard to do. It depends on how your loved one expressed their own wishes about their medical care and your discussions with healthcare providers and family. The decision is easier when you receive a thorough assessment about the benefits and risks for your loved one.

• What is the difference between a G tube and a PEG tube?

  The terms PEG tube and G tube are often used interchangeably. PEG—or percutaneous endoscopic gastrostomy—is a surgical technique used for placing a G tube.

• A dangler is a term for the part of a traditional G or J tube that extends out from the abdomen. Danglers, or long tubes, are typically between 7 and 10 centimeters (2.5 to 4 inches) in length. It is anchored inside the stomach or intestines using a bumper or a balloon that is filled with water. The end of the dangler has different sized ports to put formula or food through.

• A button is a low-profile G tube that can open and close to allow for feeds. Sometimes called a MIC-KEY or a bard, it is held in place by a bumper or balloon and lies flat on the skin. A button G tube gets connected to an extension tube set with ports for feeds. After the feed, the extension set can be removed until the next feeding or left in place.

• What foods can go in a feeding tube?

  Any liquified foods can be put in a feeding tube. People on feeding tubes often receive a prepackaged formula to ensure they get appropriate nutrients.

  However, some people prefer to make their own formula with real food. To do this, prepare the food as you normally would, then blend it with lots of water to a consistency that will fit through the tube. Strain it through a colander and let cool to room temperature before putting it through the tube.

• How often does a PEG tube need to be flushed

  A feeding tube should be flushed with water after every feed. This helps to prevent the formula or food from clogging the tube. It also helps to prevent the build-up of any bacteria or other microbes.