The controversy around the Ryle’s tube feeding
By: Yakob Abdul Rahman.W.Scholer
To many non-Medical/Nursing professional the mere mentioning of Ryle’s tube = nasal-gastric feeding tube is equated to the patient’s health condition. Nothing is more erroneous as this assumption. Even though at times it is the only means of assuring that the patient receives adequate nutrition, it’s by no means an indication of the actual health condition.
Many illnesses may temporarily or permanently require a Ryle’s tube or a ‘PEG’ feeding, such as acute stroke condition, blockage in the intestinal system, unconsciousness, or difficulties in the swallowing reflex. Many of these might be purely temporary measure, while others may need long term or even continuous feeding by this regiment. Unfortunately many instances exist where elderly people, because of the difficulties of oral food intake, are placed on Ryle’s tube feeding for the mere sake of convenience as the care takers do not take the time needed by the patient to consume the food orally. While the medical requirement are beyond dispute, much needs to be questioned, where often in nursing homes patients are inserted with tubes for the sake of ‘easy feeding’. In most countries the decision of the need of inserting a Ryle’s tube is the sole responsibility of a doctor. However in many countries even non-doctors and untrained ‘nurses’ make such decision on questionable reasons.
While the nasal-gastric tube feeding might be the option of choice to ensure sufficient supply of nutrients, one must keep in mind that we deprive the person of the pleasure of taste of food. Certainly one of the pleasures the babies enjoy from the moment of first suckling of milk, and this pleasure is an innate need to ensure the intake of nutrients all along in our life time. Moreover the motion of chewing and swallowing results in production of secretion in the oral cavity keeping the mouth clean and moist and prevents fungal infection. Depriving a person of the use of his mouth merely for convenience of the care-taker is equivalent to torture.
Ryle’s tube feeding must be reserved as the last option and for as short a duration as possible. Not only the presence of such a tube in the throat is very unpleasant, I had the experience twice already, but also a source of infection due to the continuous friction created while renewing the tube generally every 14 to 21 days.
Here again it needs a lot of skill and sensitivity of the nurse to perform this procedure. No untrained person should ever do it. There are standard operational procedures - S.O.P. of inserting and controlling the correct insertion of feeding tubes to cause the minimum of discomfort and ensure the correct placement of the same.
In this way the often traumatic experience can be kept to a minimum. Experienced and skilled persons have a range of tricks which are very helpful while inserting the tube and getting the patient to cooperate with swallowing. I know of nurses who even enticed the person with small amounts of ice cream, or favourite drink (if aspiration can be prevented).
The next task is the correct use of the tube in particular when feeding a patient. The patient should always be in an upright sitting position, ensuring the head to be raised at least 30 cm above the stomach level, thereby preventing aspiration which is the most common and most dangerous complication resulting of Ryle’s tube feeding.
With proper care and skilful application there should be no major problem in Ryle’s tube or PEG feeding.
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