Drip or tube feeding

In some situations you might need feeding through a tube when you have cancer.

You might have a feed:

• through a tube into your stomach or small bowel (enteral nutrition)

• into your bloodstream through a drip into your vein (parenteral nutrition)

When you might have it

You are likely to have tube feeding if you:

• can't absorb nutrients very well from your gut (​digestive system​ ) 

• are very run down and severely malnourished before surgery

• are malnourished before starting chemotherapy or radiotherapy

• have problems with swallowing due to a cancer in the head or neck area

• have holes (fistulas) or an abscess in the food pipe (oesophagus) or stomach

• can't eat or drink as much after an operation or other types of treatment

• have a severely sore mouth or throat after a stem cell or bone marrow transplant

Before treatment

Before your operation

Before a major operation, tube feeding might help if you are severely malnourished.

Doctors usually suggest extra high calorie, high protein drinks. You have these from 8 to 10 days before your operation. But they may suggest feeds through a tube into your stomach.

It will help you to recover afterwards if you can build yourself up before your operation. You may not gain weight, but your overall health will improve. This helps you heal faster and cope with the demands of a big operation.

Before chemotherapy or radiotherapy

In some situations, a tube feed into the stomach or bowel before chemotherapy or radiotherapy treatment may help you. It could help you put on weight and may improve your general health.

A tube feed is most likely to help you if you have a head and neck cancer. You might already be malnourished and have problems swallowing before you start treatment. There is no evidence that it makes cancer treatment work any better.

During and after treatment

You might need drip or tube feeding during or after your treatment if you can’t eat or drink enough. Some treatments can make it difficult to swallow or can make your mouth and throat very sore.

If you have surgery to your digestive system, it can take some time before you can eat or drink normally. You might have a drip or tube feed to stop you becoming malnourished.

Advanced cancer

Tube or drip feeding might help you feel better if you have advanced cancer and can't eat. There is no real evidence that it would reverse ​cachexia​ .

Read more about managing diet problems in advanced cancer

Enteral nutrition

Enteral nutrition means you have a liquid feed through a tube into your stomach or small bowel. You might need to take all your food and drink this way. Or you may take some food by eating normally, and then have the rest as a liquid through the tube.

The feeds are specially prepared and different mixtures (formulas) are available. Your dietitian chooses the most appropriate one for you. This depends on your particular nutritional needs.

Enteral feeding is only for people whose stomach and intestines work as usual. This is because the feeds still go through the digestive system.

You can't have enteral feeding if you have:

• a blockage in the bowel

• severe diarrhoea or sickness

When you might need it

You might need enteral feeding when:

• you have swallowing problems

• you have a sore mouth

• there is a risk that food and fluid can go down the wrong way

• you are unable to eat or drink enough

• you are malnourished, or at risk of being malnourished

Side effects

Enteral feeding can sometimes have side effects. These include:

• acid from your stomach coming back up (reflux) into the food pipe

• vomiting

• bloating

• diarrhoea

• constipation

You might need to have your feeds at a slower rate if this happens. It is common to start slowly and then build up the amount gradually. Your dietitian might also suggest other changes such as the type of feeding you are having or the temperature of the feed.

You may need extra fluids through a drip to prevent dehydration if you have diarrhoea.

Different types of tubes

Several types of tubes are used for enteral feeding:

Nasogastric (NG) tubes

A nasogastric (NG) tube is a thin tube that goes in through your nose and down your throat into your stomach. You might have this if you need feeding for 2 to 4 weeks.

A nurse or a doctor puts the tube in. It is not pleasant but is a quick procedure. An NG tube doesn't affect your ability to breathe or speak. You can still eat and drink with the tube in place unless your medical team tell you not to.

Nasojejunal (NJ) tube

Some people might have a nasojejunal (NJ) tube.

An NJ tube is like a nasogastric tube, but the tip goes into the second part of the small bowel (the jejunum). 

Your doctor might suggest an NJ tube:

• when your stomach cannot empty properly

• to get past a blockage in the small bowel

• after surgery to your digestive system

Jejunostomy tubes (JEJ, PEJ or RIJ tubes)

A jejunostomy (JEJ) tube goes into a part of the small bowel called the jejunum. The jejunum is situated a little way after the stomach. The tube is inserted through a small hole made on the outside of your tummy (abdomen).

They can be inserted in different ways:

JEJ tube

This types of tube is inserted during surgery to your stomach or food pipe (oesophagus).

Percutaneous endoscopic jejunostomy (PEJ) tube

To put a PEJ tube in you have an endoscopy. The surgeon puts a tube with a camera on the end through your mouth. The tube goes down your food pipe and into your stomach. This way, they can see where to place the PEJ tube. The surgeon then puts the jejunostomy tube through an opening in the tummy (abdomen) and into your jejunum. You have ​sedation​ for this procedure.

Radiologically inserted jejunostomy (RIJ) tube

You may have a RIJ tube put in with the help of an x-ray (radiologically inserted jejunostomy) if you can't have an endoscopy. You might have this procedure under ​local anaesthetic​ . Or you might have sedation.

With a jejunostomy tube, you usually have feeds at a slow rate. You have a pump that controls the speed of the feed passing into the tube.

Percutaneous endoscopic gastrostomy tubes (PEG tube)

A gastrostomy tube goes into your stomach through an opening made on the outside of your tummy (abdomen). You might have one if you have longer term problems with eating and swallowing. For example, with cancer of the head and neck or cancer of the food pipe (oesophagus).

A gastrostomy is inserted in different ways:

• during an endoscopy – this is a percutaneous endoscopic gastrostomy (PEG) tube 

• with the help of an x-ray – this is a radiologically inserted gastrostomy (RIG) tube 

To have a PEG tube the surgeon puts a tube with a camera on the end through your mouth. The tube goes down your food pipe and into your stomach. This way, they can see where to place the PEG tube. The surgeon then puts the tube through an opening in the tummy (abdomen) and into your stomach. You have sedation for this procedure.

If you have a RIG tube, you have this put in under local anaesthetic. The area on your tummy will be numbed. You will be awake during the procedure.

Gastrostomy feeds usually run for most of the day through a pump. You have a break of a few hours to give the stomach a rest. But sometimes feeds can go in over 24 hours at a low rate. If you have feeds at home, your dietitian will guide you about how much feed you need and the timings.

This diagram shows the position of a percutaneous endoscopic gastrostomy (PEG) feeding tube

A detailed diagram of a percutaneous endoscopic gastrostomy (PEG) feeding tube

Read more on having an endoscopy

Parenteral nutrition

Parenteral nutrition (PN) is when you have a feed into your bloodstream through a drip into a vein. The feeds don't go through your digestive system.

When you might need it

You are only likely to need PN feeding when your gut is not working. For example, if you:

• have severe sickness

• have severe problems with your stomach or small bowel (intestine), or if they have been removed

• have severe nutritional problems before surgery and can't have enteral feeding

• have a hole (fistula) in your stomach or oesophagus

• are losing a lot of weight or not coping well with enteral feeding

How you have it

You have PN through a central line or a PICC line. A PICC line goes up a blood vessel in your arm and into a chest vein. Other types of central lines go into the chest and a major blood vessel. The end of the line sits on the outside of your chest. It is fixed in placed.

When it is not in use, a cap seals the central line. When you have your feed, a nurse removes the cap and connects the line to the drip containing your PN.

When all the feed has gone through, the nurse flushes the line. This is with either sterile salt water or an anti clotting solution. The nurse then seals the line again.

You usually have the line put in under local or general anaesthetic. A specially trained nurse or doctor does this procedure. There can be complications. Sometimes lines get infected or blocked and have to be taken out and replaced.

About PN feeds

The feeds used for PN are very complex. They are carefully made up in a sterile room each day by a pharmacist.

Doctors and dietitians tell the pharmacist about your specific nutritional needs each day. They will check you regularly while you have PN. You will need frequent blood tests to check that your blood is normal. These include your levels of minerals, sugar, salts and other substances.

PN can have side effects. These include a high blood sugar level, or they may affect the way your liver works.

Your doctor gradually reduces your PN feeds when it is time for you to stop having them.