05 Jun Life-Sustaining Treatments – The Big Three: CPR, Mechanical Ventilation, and Feeding Tubes: Part 3
Life-Sustaining Treatments (LSTs) Part 3: Feeding Tubes
A feeding tube is a kind of life-sustaining treatment used to give nutrition, medications, and fluids directly into the gastrointestinal tract when a person cannot eat enough or cannot eat safely due to swallowing problems. Examples of conditions causing this kind of problem include cancer treatment, recovery from major surgery, medical conditions that affect the nerves and muscles, or brain damage due to trauma or oxygen deprivation. A feeding tube is also sometimes required for a critically ill person on a ventilator.
One kind of feeding tube goes into the nose, down the throat, and into the stomach. Another kind of feeding tube goes through the abdominal wall and into the stomach or intestines. The former is called a nasogastric tube, and the latter may be either a gastrostomy (placed in the stomach) or jejunostomy (placed in the small intestine). A nasogastric tube is used short term when a person is expected to recover their ability to eat and swallow. Gastrostomy or jejunostomy placement is considered when a person is going to need a feeding tube for weeks to months or more. This kind of tube requires a surgical procedure. Most people with a nasogastric tube are in the hospital. A person with a gastrostomy/jejunostomy can usually manage their feeding tube at home.
Feeding tubes can cause internal and external bleeding, infection, skin irritation, nausea, vomiting, and diarrhea. The tube can get blocked or fall out. If this happens it may need to be replaced in the emergency room or hospital. Some people find feeding tubes to be uncomfortable, particularly nasogastric tubes, although some people experience discomfort at the site of a gastrostomy/jejunostomy as well.
With some swallowing problems, there is a danger that food or fluids could go “down the wrong pipe” and into the lungs. This can cause pneumonia. A person can also inhale fluid from the tube feeding from the stomach and into the lungs. It is not clear whether feeding tubes reduce this risk. For some people with a serious illness that gets worse over time, getting weaker and not being able to eat can be a sign that they are getting closer to dying. In the very late stages of many diseases, a person’s organs stop processing food and water normally. There is no evidence that feeding tubes help people live longer when they are in the last stages of a severe and incurable illness such as dementia or cancer.
If a person chooses not to have a feeding tube, they would still receive care to help them to be as comfortable as possible. Sometimes a person who has trouble eating on their own can get enough nutrition when someone feeds them.
In the last stages of severe, incurable illness when death is near, people stop eating and drinking as part of the natural end-of-life process. When this happens, many families worry that their loved one is dying because they are not eating. In reality, the person is not eating because they are dying.
Without any fluids or nutrition at all, some people feel hungry or thirsty at first and others do not. Giving ice chips, using mouth swabs, and applying lip balm help to keep the mouth and lips moist. The amount of time a person can survive without food depends on their overall health, body weight, and whether or not they are taking in fluids. Some people who are not eating at all but taking sips of water have been known to live for weeks to months, and some people who are eating even very small amounts food and fluids might live for years.
We equate food and fluids to be essential for basic survival needs, but like all other life-sustaining treatments, a feeding tube may or may not help a person live longer. Whether a feeding tube is the right choice for a person depends on their goals for treatment and personal values.