1) NASOGASTRIC TUBE

- inserted through one of the nostrils, down the nasopharynx and into the alimentary tract
- Are used for feeding clients who have adequate gastric emptying and who require short-term feedings.
- Not advised for feeding clients without intact gag and cough reflexes since the risk of accidental placement
of the tube into the lungs is much higher in those clients.
- Other purposes:
o To prevent nausea, vomiting and gastric distention following surgery. In this case, the tube is
attached to a suction source.
o To remove stomach contents for laboratory analysis.
o To lavage (wash) the stomach in cases of poisoning or over-dose of medications

2) PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG)

- An endoscopic medical procedure in which a tube (PEG tube) is passed into a patient's stomach through the
abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate.
- Procedure is an alternative to surgical gastrostomy insertion, and does not require a general anesthetic; mild
sedation is typically used.
- Used for long-term nutritional support, generally more than 6-8 weeks.
- Tubes are placed surgically or by laparoscopy through the abdominal wall into the stomach.
- Indications:
o Head and neck cancers. PEG has become the most acceptable and safest method for long term
feeding support. It is useful particularly when surgery is extensive and when combined with
chemotherapy, radiotherapy or both.
o Malignant bowel obstruction including esophageal cancer
o Neurological conditions are the most common indications for PEG and include:

 Stroke (usually the most common indication for PEG and often vertebrobasilar stroke)
 Disorders of swallowing
 Multiple sclerosis
 Neurosurgical disease
 Parkinson's disease
 Brain tumours
 HIV encephalopathy
 Neonatal encephalopathy
 Dementia (in which use is common but controversial)
  Head injury patients

3) TOTAL PARENTERAL NUTRITION (TPN)/ Parenteral Nutrition (PN)/ Intravenous Hyperlimenation (IVH)
- Provided when the gastrointestinal tract is nonfunctional because of an interruption on it’s absorptive
capacity is impaired.
- Administered intravenously such through a central venous catheter into the superior vena cava.
- Feedings are solutions of dextrose, water, fat, proteins, electrolytes, vitamins and trace elements.
- TPN solutions are hypertonic thus they are injected only onto high-flow central veins, where it is diluted by
the client’s blood.
- A means of achieving an anabolic state in clients who are unable to maintain a normal nitrogen balance.
(e.g. clients with severe malnutrition, burns, bowel disorder, acute renal failure)
- Not risk-free

Reference:

Kozier, B., Berman, A. et.al (2008) Fundamentals of Nursing, p. 1265-1267, p.1269, p.1271.

http://www.patient.co.uk/doctor/PEG-Feeding-Tubes-Indications-and-Management.htm

http://en.wikipedia.org/wiki/Percutaneous_endoscopic_gastrostomy