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In Which Case Would a Tube Feeding Be Preferred Over Parenteral Nutrition¹

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Many chronic health problems require special dietary needs, like enteral or parenteral feeding. If your loved one is unable to swallow or digest food normally, these nutritional regimens may be necessary. But what's the difference between enteral and parenteral feeding? And how can you ensure you're providing the best possible care?

To assist you on your journey, we've developed a comprehensive guide to enteral vs. parenteral feeding and nutrition.

What's the difference between enteral and parenteral feeding?

The terms enteral and parenteral sound and look similar, but they're two different things.

Enteral feeding

Enteral feeding refers to liquid nutrition processed by the gastrointestinal tract. Individuals who are prescribed enteral feeding consume their meals through a tube that connects to their stomach or small intestine. Sometimes, enteral feeding provides supplemental nutrition; other times, it accounts for a patient's entire caloric intake.

Parenteral feeding

Parenteral feeding refers to liquid nutrition processed by the veins. It's considered riskier than enteral feeding, but often results in improved health and energy. Some people undergo parenteral feeding while recovering from surgery or other medical procedures, while others require it long-term.

Why would someone need enteral vs. parenteral nutrition?

There are several reasons someone might need enteral or parenteral nutrition:

Enteral nutrition

Enteral nutrition reduces the risk of malnourishment, or a lack of vitamins, minerals, and nutrients. If your loved one isn't able to eat enough calories throughout the day, they're more likely to lose weight and experience serious health problems.

Common conditions that may benefit from enteral feeding include:

  • A stroke

  • Cancer

  • Dysphagia (difficulty swallowing)

  • Neurologic or movement disorders (Ie: Parkinson's disease or Alzheimer's disease)

  • Critical injuries

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Parenteral nutrition

Parenteral nutrition is like enteral nutrition in that it helps prevent malnourishment. However, it's designed to assist individuals who have gastrointestinal issues that prevent them from properly digesting food.

Common conditions that may benefit from parenteral nutrition include:

  • Crohn's disease

  • Cancer

  • Short bowel syndrome

  • Ischemic bowel disease

  • Low blood flow to the bowels

Parenteral feeding administers sugar, carbohydrates, proteins, lipids, and other nutrients through a needle and into a vein. These nutrients ensure your loved one receives the energy and hydration they need to thrive.

What are the types of enteral vs parenteral feeding?

Enteral and parenteral feeding fall into several sub-categories. Your loved one's primary care physician makes a recommendation based on their age, current health, medical history, and nutritional needs.

There are six main types of enteral feeding, including:

  1. Nasogastric tube (NGT). A nasogastric tube is inserted through a nostril and into the stomach.

  2. Orogastric tube (OGT). An orogastric tube is inserted through the mouth and into the stomach.

  3. Nasoenteric tube. A nasoenteric tube is inserted through a nostril and into the intestines. (There are two subtypes of nasoenteric tubes, including nasojejunal tubes and nasoduodenal tubes. These tubes are run into a specific part of the intestine, either either the jejunum or duodenum.)

  4. Oroenteric tube. An oroenteric tube is inserted through the mouth and into the intestines.

  5. Gastrostomy tube. A gastrostomy tube is inserted through a small incision in the abdomen, directly into the stomach.

  6. Jejunostomy tube. A jejunostomy tube is inserted through a small incision in the abdomen, directly into the jejunum, a part of the small intestine.

Shop our enteral feeding medical supplies or read our detailed guide on enteral feeding.

As previously mentioned, parenteral feeding is designed for people with gastrointestinal or digestive issues. There are two main types of parenteral feeding, including:

  1. Total parenteral nutrition (TPN). If your loved one has long-term nutritional needs, they receive TPN. TPN requires a brief outpatient procedure. It involves a medical provider inserting a central catheter into the superior vena cava, a major vein that carries blood from the head and chest to the heart. To make the feeding process easier, your loved one's primary care provider might also recommend installing a needleless access port.

  2. Peripheral parenteral nutrition (PPN). If your loved one is recovering from an operation or another medical procedure and only has short-term nutritional needs, they receive PPN. PPN is administered through a traditional, external IV instead of an internal one.

Does enteral or parenteral nutrition present risks?

Enteral and parenteral nutrition are considered safe and usually well-tolerated. Even so, it's important to understand there are risks.

Potential side effects of enteral nutrition include:

  • Food getting into the lungs (aspiration)

  • Infection of the tube or insertion site

  • Nausea and vomiting

  • Diarrhea

  • Skin irritation

  • Tube blockage

  • Tube dislodgement

If your loved one only needs enteral nutrition for a short time, they might also experience gastrointestinal discomfort as they readjust to solid foods.

Potential side effects of parenteral nutrition include:

  • Catheter infections

  • Blood clots

  • Liver disease

  • Bone disease

  • Fatigue

  • Memory loss

  • Increased urination

To reduce the risk of these and other issues, it's crucial to regularly clean and sterilize each feeding component, including tubes, catheters, and needleless access ports. If you have any questions about proper hygiene or sanitation, speak with your loved one's primary care physician.

What is the outlook for someone using enteral vs. parenteral feeding?

Both enteral feeding and parenteral feeding require significant lifestyle changes. It's normal to feel stressed out or overwhelmed, especially during the first few days or weeks. If you have questions or concerns at any point, contact your loved one's doctor, nutritionist, or home health providers. They can correct any mistakes, provide key insights, and help you establish a feeding routine.

After making the switch to enteral or parenteral nutrition, your loved one will experience enhanced energy and improved health. At each subsequent check-up, their doctor will run tests and reevaluate their nutritional needs, making adjustments to the treatment plan as necessary.

Frequently Asked Questions – Enteral vs. Parenteral Nutrition

Why is enteral feeding preferred over parenteral feeding?

Medical providers typically recommend enteral feeding over parenteral feeding. That's because it's less costly, easier on the body, and presents fewer complications. In addition, enteral feeding allows for more efficient nutrient consumption and encourages the body's natural healing process by stimulating intestinal blood flow.

What is the difference between enteral and parenteral routes of administration?

Enteral nutrition is administered through a feeding tube placed into the stomach or intestines.

Parenteral nutrition is administered through a traditional intravenous (IV) line or via a central IV surgically placed during an outpatient procedure.

Enteral and parenteral syringes look very similar, but the tip of the syringe differs. The enteral syringe has a longer, cone-like shape that narrows at the tip. A parenteral syringe is short and has a small, round tip that twists onto the end of the IV.

Why is enteral a better choice over parenteral nutrition?

Enteral nutrition isn't necessarily better than parenteral nutrition, but it is less invasive and sends nutrients directly to the gastrointestinal tract. For people recovering from an illness or injury, it presents a safe and effective way to maintain energy and promote healing. What's more, feeding tubes are easier to clean and sterilize than IVs, catheters, or ports.

What is the difference between TPN and PPN?

Total parenteral nutrition (TPN) is prescribed to people with damaged or poorly functioning digestive systems. Before your loved one can receive TPN, a surgeon places a vascular access device, like a peripherally inserted central catheter (PICC), into their superior vena cava.

Peripheral parenteral nutrition (PPN) is less invasive. It's recommended for people who have temporary nutritional needs. With PPN, nutrition is administered via a traditional IV, through a needle, and into a vein.

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Source: https://www.carewell.com/resources/blog/enteral-vs-parenteral/

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