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Enteral feeding refers to liquid nourishment being inserted directly into the stomach through a feeding tube. This procedure is generally performed for patients who cannot eat on their own due to various illnesses or other complications. The liquid can either be produced using glucose, water, and other nutrients; infants may be given formula or breast milk.
In order for enteral feeding to be effective, the patient must have a functioning digestive tract but be unable to chew, swallow, or otherwise ingest food normally. The tube is often placed directly into the stomach through the abdomen and can be closed off or plugged when not being used. This allows patients who are required to use the feeding tube long-term to stay home and administer nourishment themselves. Other times the tube is inserted into the throat.
Those who use enteral feeding techniques may also be able to have regular food to enjoy the sensation of chewing, taste, and fellowship with friends or family. This is possible for those who can readily chew and digest food, but may have issues with aspiration or malnutrition when food is the sole source of nourishment.
There are many benefits for those who use enteral feeding when needed. These include increased weight gain in malnourished patients, easier breathing or less risk of aspiration for those with lung or airway restrictions, and a better quality of life for patients who struggle to eat solid foods. While solid foodsshould be offered when feasible, a patient can live and be nourished using only enteral methods.
Disadvantages of enteral feeding include diarrhea, skin breakdown, anatomic disruption, hyperglycemia, and hyperphosphatemia. These risks can generally be avoided or dealt with with proper medical care and prompt attention when symptoms become apparent. Some patients may also experience dislodged or displaced tubes, although this can generally be corrected fairly easily.
Patients who may be candidates for enteral feeding must meet certain criteria. Aside from obvious malfunctions of the swallowing mechanism, symptoms which may warrant tube feedings include severe weight loss, lack of weight gain in small children in the period of three months, not enough vitamins being absorbed into the body from food, low weight for height, and failure to thrive for small children when combined with one or more of the previous symptoms. In most cases there is an underlying medical condition for these symptoms which must be discovered and remedied before natural food absorption can commence.
@SailorJerry and jennythelib - You both raise good points, but I want to remind you that both ventilators and enteral feeding can also be used for people who *will* recover!
Some people use enteral feeding for years and live otherwise normal lives; their problems may be purely digestive rather than neurological or muscular.
And ventilators are often used for premature infants, accident victims, etc. who need help breathing in the short term, but who in the long term will get better.
Just wanted to make the point that it's not always a question of when to unplug the patient!
@jennythelib - Yes, I'm pretty sure that Terri Schiavo had an enteral feeding tube. But she could breathe on her own, which I think is where the controversy came in.
A lot of people are more okay with the idea of turning off breathing support (i.e., a ventilator) than removing a feeding tube. For one thing, when a ventilator is turned off, it's a much quicker way to go, and for another, a person on a ventilator is more clearly incapacitated.
Because of the complicated ethics, many people with terminal illnesses want to avoid feeding tubes in the first place at the end of their lives. They know that once it goes in, getting it removed is a big
deal. My grandmother, for instance, was offered a feeding tube. It might have made her a little more comfortable in the short term, but it might have extended her life by days or weeks in a mostly unconscious state. She wasn't OK with that and refused to have it put in at all.
Is enteral nutrition the kind of "feeding tube" used for patients in a vegetative state? I remember the Terry Schiavo case from a while back. She was in a persistent vegetative state and her husband wanted to have her feeding tube removed, insisting that she would not have wanted to be kept alive in that state.
Her parents objected. They felt that Terry responded to their presence and that it would be cruel to allow her to starve to death, which is what happens when the tube is removed from someone who is unable to eat like that.
And I figure if there was one case that made big headlines, there are probably dozens more that were handled quietly, out of the courts.