This has come from Question 15 from the first paper of 2003, and Question 20 from the first paper of 2008. Elsewhere, there is a brief summary of the routes of enteral nutrition and it contains the table displayed below.
~Enteral Feeding Routes~
A Comparison of the Nasogastric Tube, Percutaneous Endogastic Tube and Feeding Jejunostomy
| Tube type |
Advantages |
Disadvantages |
| Nasogastric |
- Easy to insert
- The tubes are cheap
- Gastric aspiration is possible
- Gastric food delivery buffers gastric acids and protects the gastric mucosa
- The gastric acid has a bactericidal action which helps prevent gastroenteritis
- Gastric secretions (gastric pepsin and lipase) facilitate absorption of feeds, which means one is not limited to any specialised feed mixtures
|
- Uncomfortable in the awake patient
- It is easily dislodged by a delirious patient
- It may increase aspiration risk because the gastro-oesophageal sphincter is less competent when there is something constantly in it.
|
| Nasojejunal tube |
- Decreased risk of aspiration.
- Decreased stimulus to pancreatic secretion.
|
- Uncomfortable in the awake patient
- Difficult to place.
- Not exactly cheap
- One must wait for the tip to migrate into the jejunum
- Impossuble to administer large boluses.
- Gastric mucosa is unprotected from acid, and loses trophic stimulus
- The feeds do not benefir from the bactericidal eactivity of stomach acid
- Absorption may be impaired due to the loss of gastric pepsin and lipase; specialised mixtures may be required
|
| PEG tube |
- Improved tolerance in the awake patient
- None of the facial pressure are complications
- No sinusitis or mucositis
- No risk of oesophageal stricture
- Better tolerance in the extremely long term (one can have a percutaneous tube for their entire life)
- Nice, large bore tube - less likely to block
- All the advantages of gastric feeding (eg. tolerance of bolus feeds, sterilising effects of stomach acid and usefulness of gastric digestive enzymes)
- All the advantages of NG sumps - can aspirate and sample gastric contents
- Less likely to result in aspiration, as it does not interfere with the gastrooesophageal sphincter.
- Alows earlier feeding, as poor gastric emptying is not an issue
|
- Needs to be surgically placed
- Requires endoscopy to position
- Risk of early dislodgement and loss of the imamture fistula tract
- Tube can block unless it is wide-bore
- Skin erosion and ulceration may take place.
|
| Feeding jejunostomy |
- Improved tolerance in the awake patient
- None of the facial pressure are complications
- No sinusitis or mucositis
- No risk of oesophageal stricture
- Least likely to be dislodged
- Alows earlier feeding, as poor gastric emptying is not an issue
- Decreased stimulus to pancreatic secretion.
|
- Needs to be surgically placed
- Requires endoscopy, or more usually laparoscopy, to position
- It is a small bore tube which is blocked more easily
- One can neither aspirate it, nor bolus-feed through it
|