As end of life approaches, it’s common for hospice patients to lose their appetites. That’s because organs and systems start shutting down, and the body simply does not want or need fluids and food like it did before. This can pose a difficult decision for the family: should a feeding tube be inserted or not? Your hospice care team doctor will be able to shed some light on the science of it, but ultimately the decision lies with the family, or more specifically, the health care proxy.

As we head into Feeding Tube Awareness Week February 5 through 9, we are reminded of the importance and gravity of this decision. But that decision doesn’t just focus on when to insert a feeding tube; it also involves deciding when, or even if, to remove it. Hospice care in Alameda County explains the feeding tube options available and how to make those difficult decisions.

What is a Feeding Tube?

First, let’s define what a feeding tube, or nasogastric (NG) tube, is. This tube is threaded through the nose down to the stomach to provide nutrition for a short time, says the NIH. If a feeding tube is required for the long-term, a gastric or G tube is placed directly into the stomach through an opening in the abdomen. We’ll focus on short-term NG tubes for the purpose of this article. Those tubes can certainly be uncomfortable for patients, and often times, they try to yank it out. This can lead to the need for restraint, yet another area of concern when facing this decision.

The comfort level of patients and their families is something we take seriously here at Pathways Home Health and Hospice. As a result, we always make it a point to sit down with you and educate you on the need for feeding tubes as they arise during your loved one’s hospice stay. Opting for a feeding tube for your loved one is never easy, and it’s not a simple black-or-white, yes-or-no, situation. It’s important to get the information and counseling you need to make the right decision.

Considerations

There are many facets that affect the decision to insert a feeding tube.

• Declining a feeding tube: If you decide to decline the feeding tube, the patient will be given foods orally in small amounts to their tolerance. They can’t consume enough calories to maintain their weight, but remember, they do not feel hunger like healthy people do. Comfort measures should be taken to ensure the patient does not experience pain or shortness of breath.
• Know the difference in feeding tube options: Enteral feeding tubes deliver water, other liquids or pureed foods; parenteral nutrition can be partial (some of the nutrients necessary for the body) or total (all of the basic nutrients needed to produce energy and keep weight on).
• Know the side effects of inserting a feeding tube: Central catheters can cause infection, sepsis, collapsed lungs, vein clots, cardiac arrhythmias and electrolyte disturbances — all of which can be potentially life-threatening. NG tubes can cause choking and extreme discomfort. When inserted incorrectly in the trachea, this can lead to pneumonia. The tube can cause erosions and abrasions in the nasal passages, esophagus, and stomach, and can result in bleeding. If restraint is necessary, agitation and anxiety can result, as an injury. NG tubes can potentially become blocked, torn, or dislodged, and they can also cause the development of ulcers or infections of the sinuses, throat, esophagus, or stomach, according to Healthline.
• Know the benefits: Today’s Dietitian points out that nutrition support in hospice benefits patients by reducing physical deterioration, improving quality of life, and preventing the emotional effect of “starving the patient to death.”

The Role of Hospice

In general, the inability to eat marks the beginning of the end-of-life journey. Those with terminal diagnoses may be eligible for hospice care, which involves a team approach to decision-making. Your team will comprise clergy, nurses, social workers and physicians who can provide you with the guidance you need to get through the process and make the best decisions possible for your loved one. Counseling is always available for family members and patients in an effort to clarify late-life issues.

Many families agonize over the decision to start, withhold, or discontinue artificial nutrition and hydration. Perhaps this is rooted in the belief that providing nutrition to our loved ones is so deeply connected to the act of nurturing our babies and families. This propensity to nurture is so deeply ingrained in us that it can be very difficult to step back and view artificial nutrition and hydration in the hospice setting as a medical treatment, with both benefits and complications associated with its use. Decisions regarding feeding tubes should be made from a clinical point of view, which is where the guidance of your hospice care team comes in.

Contact Pathways Home Health and Hospice

For more explanation on feeding care options, get in touch with the hospice care team in Alameda County at Pathways Home Health and Hospice. Contact us today at 888-755-7855 to learn how we can guide you through this time.