Delivery Systems

Nasoenteric tube feeding dates back as far as the fifteenth century; modern use began in the early 1950s with the development of fine polyethylene tubes and feeding pumps (105). In the 1960s, the development of total parenteral nutrition (TPN), which was viewed as more sophisticated and problem free, contributed to reduced use of enteral tube feeding in the 1970s and early 1980s. However, tube feeding is now resurging because of a number of factors. Enteral nutrition is less expensive than TPN (106) and results in fewer serious complications (107). Research shows that enteral feeding maintains gut mass, integrity, and function better than parenteral nutrition (1). The use of small-bore tubes made of soft biocompatible materials has led to increased patient tolerance of nasally placed tubes.

Most feeding tubes are now made of polyurethane or silicone, which does not disintegrate or become brittle over time and therefore does not need frequent replacement. Feeding tubes are mostly easily inserted into the stomach by way of the nasopharaynx. If the patient is at high risk for aspiration, the tube can be passed further down into the duodenum or jejunum, although it is sometimes difficult to get the tube through the pylorus (105). If the transversal route is not possible or long-term feeding is desired (more than six weeks) tubes can be inserted directly into the esophagus or into the stomach or duodenum through the abdominal wall. (Tube placements are depicted in Figure 1.) Cervical pharyngostomies, or more rarely, esopha-gostomies are performed when the access site has been obtained during surgery for head and neck cancer or surgical repair of the maxillofacial area (108). Feeding gastrostomies can be placed surgically or percutaneously (109); the advantage of percutaneous endoscope placement is that it can be done as an outpatient procedure by gastroenterologist with local anesthesia. Feeding jejunostomies are usually performed in conjunction with other intestinal surgery, facilitating early nutrition support. The diameter of feeding tubes is described in French (F) units (F unit = 0.33 mm). Large-diameter tubes (> 16 F) tend to cause

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Nasogastric Nasoduodenal

Nasojejunal

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