nutritional disorders
Enteral Tube Nutrition
Procedure
If tube feeding is needed for≤4 to 6 weeks, a small-caliber, soft nasogastric or nasoenteric (eg, nasoduodenal) tube made of silicone or polyurethane is usually used. If a nasal injury or deformity makes nasal placement difficult, an orogastric or other oroenteric tube can be placed. Tube feeding for>4 to 6 weeks usually requires a gastrostomy or jejunostomy tube, placed endoscopically, surgically, or radiologically. Choice depends on physician capabilities and patient preference. Jejunostomy tubes are useful for patients with contraindications to gastrostomy (eg, gastrectomy, bowel obstruction proximal to the jejunum). However, these tubes do not pose less risk of tracheobronchial aspiration than gastrostomy tubes, as is often thought. Jejunostomy tubes are easily dislodged and are usually used only for inpatients. Risk of tracheobronchial aspiration with jejunostomy tubes is as high as with gastrostomy tubes. Feeding tubes are surgically placed if endoscopic and radiologic placement is unavailable, technically impossible, or unsafe (eg, because of overlying bowel). Open or laparoscopic techniques can be used. 