Feeding Tubes - Enteral Feeding Tubes - PEG, Nasogastric, Gastrostomy

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  1. MIC-Key Tube SECUR LOK Extension Feeding Sets
    very good.
    Exactly what I needed and the way it was shown on the web page
    (Review by mim)
  2. Kangaroo Gastrostomy Feeding Tubes with Y Port and Safe Enteral Connections Silicone
    Kangaroo Gastrostomy Feeding Tubes.
    The balloon on this Gastrostomy feeding tube seals off the internal stoma to prevent fluid leakage.
    (Review by Abner T)
  3. Tech MINI ONE Balloon Button
    Mini One Balloon Button Review.
    My doctor prescribed me to use the balloon button for my son Miguel. We have bought two other brands and this is the only one that worked well for him.
    (Review by Harold)
  4. MIC-Key Tube SECUR LOK Extension Feeding Sets
    Product does its job. Service is commendable..
    I am never really into health and medical science so I did not really know anything about medical supplies. So when my doctor told me to get this, I was
    (Review by Ulysses)
 

Feeding Tubes - Enteral Feeding Tubes - PEG, Nasogastric, Gastrostomy & More!

Feeding Tube

Manufacturer
  1. Amsino International (3)
  2. Applied Medical (2)
  3. Ballard (1)
  4. Bard (3)
  1. CURITY (2)
  2. Compat (3)
  3. Corpak (9)
  4. Covidien (2)
  1. Kendall (6)
  2. MICKEY (4)
  3. Nestle (1)
  4. Teleflex Medical (1)

    Feeding Tubes are medical devices which are used to deliver nutritional support to patients who are unable to ingest and swallow food. Feeding Tubes can be used for as both permanent nutritional treatment of chronic disease and disabilities or for temporary nutritional support. There are a variety of different feeding tube styles and are classified by their method and site of insertion. We carry nasogastric feeding tubes, gastrostomy feeding tubes and peg feeding tubes.

    For further information: Indications -- Contraindications -- Types of Feeding Tubes -- Sizing -- Tube Feeding Calculating -- Complications

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    1. MIC-KEY Tube SECURE LOK Extension Set for Feeding

      MIC-Key Tube SECUR LOK Extension Feeding Sets
      $10.73
      Kimberly Clark

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    2. MIC-KEY Tube LOW PROFILE Gastrostomy Feeding Tube Kit

      MIC-KEY Tube LOW PROFILE Gastrostomy Feeding Tube Kit
      $135.00
      Kimberly Clark

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    3. Curity PVC Nasogasrtic Feeding Tubes

      Curity PVC Nasogasrtic Feeding Tubes
      $1.01
      Covidien

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    4. Kimberly-Clark MICKEY Tube Gastrostomy Feeding Tube

      MIC-KEY Tube Gastrostomy Feeding Tube
      $23.23
      Kimberly Clark

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    5. Bard Tri-Funnel Replacement Gastrostomy Feeding Tube

      Bard Tri-Funnel Replacement Gastrostomy Feeding Tube
      $71.62
      Bard

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    6. MIC-KEY Feeding Extension Set with Stepped Connectors

      MIC-KEY Feeding Extension Set with Stepped Connectors
      $3.21
      Kimberly Clark

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    7. Curity PVC Pediatric Nasogastric Feeding Tubes

      Curity PVC Pediatric Nasogastric Feeding Tubes
      $1.46
      Covidien

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    8. Bard Nasogastric Feeding Tube 8 Fr 42 Inch

      Bard Nasogastric Feeding Tube 8 Fr 42 Inch
      $2.15
      Bard

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    9. Y Extension Set

      Y Extension Set
      $2.23
      Corpak

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    10. Corflo-Ultra Lite NG Enteral Feeding Tube Non-Weighted with Stylet

      Corflo-Ultra Lite NG Enteral Feeding Tube Non-Weighted with Stylet
      $14.23
      Corpak

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    11. MIC-KEY Bolus Gastrostomy Feeding Tube

      MIC-KEY BOLUS Gastrostomy Feeding Tube
      $48.01
      Kimberly Clark

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    12. Argyle Indwell Polyurethane Nasogastric Feeding Tubes

      Argyle Indwell Polyurethane Nasogastric Feeding Tubes
      $8.10
      Covidien

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    13. Kangaroo Gastrostomy Feeding Tubes with Y Port and Safe Enteral Connections Silicone

      Kangaroo Gastrostomy Feeding Tubes with Y Port and Safe Enteral Connections Silicone
      $33.09
      Covidien

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    14. COMPAT® Gastrostomy Replacement Balloon Feeding Tubes

      COMPAT® Gastrostomy Replacement Balloon Feeding Tubes
      $37.84
      Nestle

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    15. Gastrostomy Feeding Tube

      Gastrostomy Feeding Tube
      $21.96
      Corpak

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    16. Tech MINI ONE Balloon Button

      Tech MINI ONE Balloon Button
      $154.52
      Applied Medical

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    17. Kendall Entriflex Nasogastric Feeding Tubes

      Entriflex Nasogastric Feeding Tubes
      $14.58
      Covidien

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    18. PEDI-TUBE Pediatric Nasogastric Feeding Tubes

      PEDI-TUBE Pediatric Nasogastric Feeding Tubes
      $12.65
      Covidien

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    19. Adult IV Administration Set with Flow Controller

      Adult IV Administration Set with Flow Controller
      $5.76
      Amsino International

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    20. CORFLO CuBBy Low Profile Gastrostomy Feeding Tube

      CORFLO CuBBy Low Profile Gastrostomy Feeding Tube
      $6.03
      Corpak

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    21. MIC PEG Replacement Universal Feeding Adapter

      MIC PEG Replacement Universal Feeding Adapter
      $12.39
      Kimberly Clark

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    22. MIC PEG Replacement Bolus Feeding Adapter

      MIC PEG Replacement Bolus Feeding Adapter
      $18.40
      Kimberly Clark

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    23. Applied Medical Tech MINI Classic Button Gastrostomy Tube

      Applied Medical Tech MINI Classic Button Gastrostomy Tube
      $156.97
      Applied Medical

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    24. Kangaroo Nasogastric Feeding Tube

      Kangaroo Nasogastric Feeding Tube
      $9.38
      Covidien

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    25. Standard Bore Needleless Extension Set

      Standard Bore Needleless Extension Set
      $2.19
      Amsino International

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    26. Bard Genie Decompression Feeding Tube

      Bard Genie Decompression Feeding Tube
      $14.80
      Bard

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    27. Corflo-Ultra Pediatric Nasogastric Feeding Tube with Stylet

      Corflo-Ultra Pediatric Nasogastric Feeding Tube with Stylet
      $17.32
      Corpak

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    28. Corflo-Ultra Nasogastric Feeding Tube with Stylet

      Corflo-Ultra Nasogastric Feeding Tube with Stylet
      $17.32
      Corpak

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    Indications

    Indications for Tube feeding require a patient to have a gastrointestinal (GI) tract that is functioning, but are unable to meet their nutritional needs via oral ingestion nutrients. When possible the GI tract should be used as it can atrophy and natural gut flora may translocate to the circulatory system which will increase infection risk. While the use of a feeding tube is most commonly used as the sole source of nutrition, it is sometimes combined with oral intake.

    More specific indications include:

    • Less than 50% of necessary nutritional intake received orally for five days
    • Coma
    • Severe dysphagia
    • Low enterocutaneous fistula output

    Contraindications

    Contraindications for enteral tube feeding can vary by the type of tube, insertion point, and duration of tube feeding. In an attempt to lump those more general contraindications together we have provided the following Feeding Tube contraindications.

    • High enterocutaneous fistula output
    • Shock or severe acute pancreatitis
    • Severe dementia
    • Advanced cancer
    • Partial or full paralyzation of the GI tract
    • Intestinal hypomotility
    • Failure to thrive
    • Intestinal obstruction
    • Aggressive nutritional support is not warranted

    Types of Feeding Tubes


    Feeding Tubes are classified by their intended use as well as the site they are inserted.

    Nasogastric Feeding Tube
    A Nasogastric Feeding Tube is also commonly called an NG-tube. When a Nasogastric Feeding Tube is used, it is inserted through the nose and passed down through the esophagus and finally in to the stomach. Nasogastric Feeding Tubes are used for short term feeding which typically does not last for longer than 2 weeks.

    Gastrostomy Feeding Tube
    A gastric feeding tube is used for long tern enteral nutrition administration for patients at low risk for aspiration.. A Gastric Feeding Tube works by being inserted through a small incision made in to the abdomen and is then pushed in to the stomach so feeding can be administered. There are three main variations to a Gastrostomy feeding tubes:

    1. PEG Feeding Tube - Percutaneous endoscopic gastronomy feeding tubes are used quite commonly. PEG Tubes are primarily used to establish the tract and stoma site as a placement tube. Percutaneous endoscopic gastronomy tubes have commonly been placed endoscopically but percutaneous placement via interventional radiology can also be identified as a PEG Tube.
    2. Standard Gastrostomy Tubes - Commonly called a G-tube or a button, these balloon or non-balloon tubes may be placed in a patient surgically as an initial or also as a replacement tube for enteral feeding. Gastrostomy tubes placed surgically are most commonly done during a laparotomy or open surgical procedure. For patients where surgical feeding tube placement is the only option a Stamm surgical gastrostomy technique is typically used. Once an initial gastrostomy tube has formed a well defined tract between the abdominal wall and the stomach, typically taking six weeks, the standard gastrostomy tube is then placed. Tract maturation times may vary from patient to patient.
    3. Low Profile Gastrostomy Tube - A lightweight deviation to the standard gastrostomy tube is the Low Profile G-Tube. Adults who are active, pediatric patients, and patients who are at risk of pulling out their feeding tubes will commonly receive a Low Profile Gastrostomy Feeding Tube. There are a few Low Profile G Tubes which are suited for initial tube placement but the majority of them have been designed to be inserted into a matured tract.

    Feeding Tube Sizing

    Feeding tubes are sized in the French scale or French unites. These units are most commonly abbreviated as Fr, but can also be communicated as Fg, FR or F. In French speaking countries they might use CH/Ch after Charriere, the inventor. 1 French unit is equal to .33 millimeters, so in order to figure the diameter of a round feeding tube you can simply divide the French size by 3. D (mm) = Fr/3 or Fr = D (mm) × 3. A French size of 12 would have a diameter of 4 mm.

    French size correlates to the exterior diameter of the feeding tube and not the diameter of the internal channel.


    Tube Feeding Calculation

    There are a large array of different tube feeding formulas which can be used for tube feeding but it's crucial to understand the nutritional needs of the patient. Once you know the amount of formula they should be receiving in a 24 hour period, the rate of feedings can then be calculated.

    1. First, you will need the patients weight in both pounds and kilograms. You can convert pounds to kilograms by dividing the pound weight by 2.2.
    2. Figure the patients height in inches.
    3. Using the Harris-Benedict Formula, we will now calculate the patients daily caloric requirement. We will first figure need the Basal Metabolic Rate, now rather than figuring this by hand we would recommend using WolframAlpha to make this easy. Click here, and enter in the patients age, body weight, height and gender, then hit enter or the the little equals sign.
    4. We will now use the Harris-Benedict Method to determine the amount of calories needed daily to maintain current weight. Select the most appropriate weekly exercise level and multiply the BMR accordingly.
      Little to no exercise Daily calories needed = BMR x 1.2
      Light exercise (1–3 days per week) Daily calories needed = BMR x 1.375
      Moderate exercise (3–5 days per week) Daily calories needed = BMR x 1.55
      Heavy exercise (6–7 days per week) Daily calories needed = BMR x 1.725
      Very heavy exercise (twice per day, extra heavy workouts) Daily calories needed = BMR x 1.9
    5. Now, in order to figure the tube feeding rate we will first need to figure the total volume of daily formula. Read the label on the formula to determine the calorie count per milliliter and the volume of the can, the majority of feeding formulas will provide 1 kcal/mL or 2 kcal/mL and are commonly 250 mL cans. Assuming you 1 kcal/mL and 250 mL cans, you will need six cans formula.
    6. Figure the rate of tube feeding by now dividing the total volume (1500 in our example) by the feeding duration. If feeding was to be provided for 20 hours of the day, the patient would require 75 mL an hour.

    Feeding Tube Complications

    Complications that may occur with enteral tube feeding cover a broad range which can typically be fall under mechanical, gastrointestinal, metabolic/biochemical and other miscellaneous complications. Additionally, complications with feeding tube use can vary with the type of tube being used.

    Nasoenteric Feeding Tube Complications
    Since the introduction of fine bore nasoenteral feeding tubes in the 1970's, complications have become far less common. The majority of complications seen are now physical and related to the finer size and varying pliability and materials used with tubes. Tube blockage is a common issue when using crushed medication or when precipitation of protein builds and causes a blockage from inadequate flushing. Additional problems specific to nasoenteric feeding tube use can include:

    • Nasopharyngeal discomfort
    • Gastro-esophageal reflux
    • Intracranial insertion - increased risk from modern tubes with internal guide wires
    • Development of tracheo-eosophageal fistulas
    • Endobronchial placement

    Surgical Gastrostomy Feeding Tube Complications
    Complications stemming from surgical gastrostomy feeding tubes are more than a few, even though the procedure has been performed for many years. The likelihood of a complication can increase depending on the patient. If patients are elderly, malnourished, suffering from a head injury, stroke, or malignancy, the chances increase; combine that with the use of general anesthesia when performing the gastrostomy can further increase risk.

    • Wound dehiscence
    • Infection
    • Leakage
    • Aspiration
    • Bleeding

    Endoscopic Gastrostomy Complications
    PEG feeding tubes have become increasingly more accepted, easier to insert and have a far lower morbidity and mortality rates. Combine those advantages with the fact that PEGs generally will not require general anesthetic and are significantly less expensive than a surgical gastrostomy. Complications from an Endoscopic Gastrostomy include:

    • Peristomal infection
    • Leakage
    • Accidental tube removal
    • Tube blockage
    • Tube fracture
    • Tube displacement
    • Peritonitis
    • Aspiration pneumonia
    • Bleeding
    • Gastric mucosa overgrowth

    Complications and Interventions
    The following recommendations should not be substituted for the advice of a medical care professional. Listed below are complications, the possible causes, and potential intervention actions.

    Complication

    Possible Cause(s)

    Intervention

    Nausea/Vomiting and Diarrhea

    Rapid administration of feeding

    • For continuous drip feeding, return infusion rate to previous tolerated level. Then gradually increase rate
    • For bolus feeding, increase length of time for feeding. Allow for short break during feeding. Offer smaller and more frequent feedings
     

    Hyperosmolar solution

    (high calorie and/or high protein formulas)

    • Switch to isotonic formula
    • Dilute current formula to isotonic strength and gradually increase to full strength
    • Check that formula is mixed properly
    • Avoid adding other foods to formula (i.e., baby food, powdered formula)
     

    Medication

    • Do not add medication to formula; give between feeding with water or juice (for infants over 6 months CA)
    • Meds that may cause diarrhea include: antibiotics, GI neurologic stimulants beta blockers, laxatives, stool softeners, liquid meds with sorbitol ie. theophyline
    • Review medication profile and change if possible
     

    Air in stomach/intestine

    • Burp child during feedings or allow for short breaks
    • Use medication to decrease gas, ie.simethicone
    • Elevate child's head during feeding and for 30 minutes after meal
     

    Tube migration from stomach to small intestine

    • Pull on tube to reposition against stomach wall
     

    Cold feedings

    • Warm feedings to room temperature
     

    Rapid GI transit

    • Select fiber enriched formula
     

    Bacterial contamination

    • Use breast milk that has been safely collected and stored
    • Refrigerate open cans of formula and keep only as long as manufacturer suggests
    • Clean tops of formula cans before opening
    • Hang only 4 hour amount of formula at a time
    • Be sure feeding sets are cleaned well
     

    Allergy/lactose intolerance

    • Switch to breast milk or lactose-free formula
    • Try soy formula. If allergic to soy, may need elemental or semi-elemental formula
     

    Excessive flavorings

    • Stop using flavorings
       
    • Decrease fat in formula or use MCT Oil
    • Refer to physician

    Constipation

    Inadequate fiber/bulk or fluid

    • Try formula with added fiber
    • Increase water
    • Try supplementing with prune juice
    • Try stool softeners, suppositories, or enema, as indicated
    • Refer to physician

    Gastroesophageal reflux

    Delayed gastric emptying

    • Refer to physician
    • May recommend medication to stimulate GI tract
    • Elevate child's head (30-45 degree angle) during feeding and for 1 hour after meal
    • Check for residuals before feeding
    • Try smaller, more frequent bolus feedings or continuous drip feeding
    • Consider Jejunal feeding

    Large residuals

    Decreased gastric motility

    • Elevate child's head during feeding
    • Use gastric stimulant to promote gastric emptying
    • Consider continuous feeds
     

    Hyperosmolar formula

    • Switch to breast milk or isotonic formula
     

    Medications

    • Do not add medications to formula; give between feeding with water or juice
    • Refer to physician

    Tube feeding syndrome (dehydration, azotemia, and hypernatremia)

    Excessive protein intake with inadequate fluid intake

    • Refer to physician
    • Decrease protein
    • Increase fluids. Monitor fluid intake and output

    Hyponatremia

     
    • Refer to physician
    • Replace sodium losses
    • Restrict fluids

    Clogged feeding tube

    Residue or coagulated protein

    Inadequate flushing of tube

    Medication

    • Use correct formula
    • Flush tubes with water after giving formula or medication
    • Flush every 3-4 hours with continuous drip feeds
    • Do not mix formula with medication
    • Irrigate with air, using syringe
    • Gently milk tubing
    • Dissolve 1/4 tsp. meat tenderizer in 10 cc water and flush to dissolve clot
    • Replace tube

    Leakage of gastric contents

    Improper positioning of child

    Tube migration

    Increased sized of stoma

    • Place child upright for feeding
    • Make sure gastrostomy tube is firmly in place
    • Stabilize tube with gauze pads, adjust crosspiece
    • If stoma is too large for tube, insert new tube
    • Keep skin around stoma clean and dry; use protective ointments and gauze
    • If leaking out of button gastrostomy, may need to replace device
    • Refer to physician

    Bleeding around stoma

     
    • A small amount of bleeding is normal
    • Tape tube securely in place to avoid irritation from movement
    • Secure tube under child's clothing
    • Refer to physician

    Infection of stoma

    Gastric leakage around tube

    Stoma site not kept clean

    Allergic reaction to soap

    • Correct cause of leakage
    • Carefully cleanse and protect stoma
    • If stoma site is irritated use plain water or change type of soap used
    • Refer to physician for culture and medication

    Granulation tissue

    Body rejecting foreign body

    Poorly fitting tube causing friction

    Use of antiseizure medication such as Dilantin

    • Keep area clean and dry
    • Adjust snugness of PEG tube with crosspiece
    • Stabilize tube using tape, bandnet, ace bandage, tube top
    • Prevent child from pulling on tube
    • Apply silver nitrate as directed by physician