Medical Conditions Related to Brain Injury
Feeding Tubes
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Immediately after injury, patients with brain injury may be unable to eat by mouth. If they are in a coma or do not have a gag reflex, they cannot eat. Even after a period of healing, some patients with serious injury may not have the strength to take all the calories needed by mouth. In all of these cases, a feeding tube can be used to provide fluids and nutrients to the body.
A feeding tube is inserted through the nose, down into the stomach, or down into the intestine if needed. A tube through the nose to the stomach is called a nasogastric tube or “NG” tube. If there is a risk of vomitting, the tube may go past the stomach and into the small intestine. Depending on where it stops in the intestine, it will be called a nasoduodenal (ND nasojejunal (NJ) or a transypyloric (TP) tube.
Feeding tubes allow normal use of the gut while skipping the chewing and swallowing part of eating. The naso-tubes do not hurt but, for some patients, they can be annoying or difficult to keep in place. If a tube will be needed for more than a few weeks, a surgeon or gastroenterologist may make a small cut and place the tube directly into the stomach or small intestine, rather than having a tube go down through the nose. This is called a gastric (g-tube) or jejunal (j-tube) feeding tube. If eating by mouth improves, these tubes are easily removed and the “hole” closes up within a few hours.
There are many liquid formulas that can be used for the feeding tube route of nutrition intake. Standard products are packaged in 8 ounce cans of about 250 calories each, with balanced protein, fiber, vitamins, minerals and water. Some products are also available in 32 ounce bottles or bags. Several “high nutrition” liquid formulas are flavored (such as chocolate or strawberry) so that they can be taken either by mouth or by feeding tube.
Major nutritional goals after a brain injury are a healthy weight, adequate fluids and fiber, and enough protein and fuel for muscle activity. Whether the person takes all nutrients by mouth, by feeding tube or by a combination of the two routes, good nutritional status is very important for recovery. Wound healing as well as physical and mental progress are greatly affected by proper nutrition.
The feeding tube should be seen as a helpful partner if it is needed.
Barbara Benoit, who completed her Dietetic Internship at Tufts-New England Medical Center, has seventeen years as full time faculty in undergraduate and graduate programs in Allied Health Sciences and sixteen years in Rehabilitation Services, both in-patient and out-patient. She is presently Staff Nutritionist, In-Patient Rehabilitation Unit, Pulmonary Clinics and GI Services at Children’s Healthcare of Atlanta at Scottish Rite.