Weaning Off the Tube: It’s Not as Simple as It Seems
The patient is ready. The team is ready. We've all been in this situation: a patient has been on a feeding tube, and everyone is eager to resume oral (PO) intake and remove the tube. It feels like a huge step forward, a sign of progress and recovery. Mentally, this can be massive—the swallowing equivalent of walking again. But here’s the thing: removing that tube isn't always as simple as it seems. It would be great if it just popped out, never to be seen again, with the patient immediately getting all the nutrition they need. But food is important, and patients deserve a systematic approach to ensure they are getting enough calories before the tube comes out.
The Problem: A Data-Driven Reality
What’s the big deal, right? If they're ready to eat, they're ready to eat. Just take the tube out and let them go. What’s the worst that could happen? A recent study by Vinci et al. reveals a stark reality: after feeding tubes were removed, patients' energy intake plummeted from 97.3% of their goal to just 65%—in a single day. Protein intake saw a similar steep drop, from 91.5% to a mere 60.6%. This would be like skipping an entire meal every single day. Those essential calories are lost to the abyss, never to be seen again. This drop in nutrition is directly linked to poor outcomes, yet feeding tube weaning is often not treated with the importance it deserves.
The Causes: Subjectivity and the "Mental Component"
So why does this happen? There are a multitude of reasons, but they often boil down to a lack of objective measurement. Quantifying a patient's intake can be tricky. While the team often performs a calorie count, these are notoriously subjective, inaccurate, and underreported. Instead of a scientific measurement, we get intermittent reports based on quick assessments, sometimes from the patient themselves. This flawed process carries all the way to the final decision to remove the tube. As the study by Vinci et al. observed, "The decision to remove a feeding tube is often influenced by the personal opinion of healthcare professionals or institutional practices, rather than on the basis of an assessment of oral energy and protein intake."
There is also a significant mental component at play for both patients and providers. The dietician and medical team put so much effort into making sure patients get adequate nutrition with the tube. But when it comes to taking away that consistent source of nutrition, the same level of vigilance is often not applied. Nobody wants to feel like they are "moving backward" by increasing tube feedings after already reducing them, or worse, needing to reinsert a tube once it's been removed. This negative perception of regression can make us less likely to objectively monitor intake and catch problems early. We call it "feeding tube liberation" for a reason—it’s an exciting moment of independence and recovery. But we must be careful not to oversimplify this important transition.
The Solution: A Systematic and Interdisciplinary Approach
The research world still has a lot to learn about the absolute "best" way to transition patients off tube feeds, especially for those who have been critically ill. But here's what we do know from a clinical standpoint: careful monitoring is key.
The journey doesn't end when the tube comes out; it simply shifts. Our goal must be to ensure a safe and effective transition back to oral nutrition, protecting our patients from the risks of inadequate intake, malnutrition, and weight loss.
Objective Monitoring: Watch caloric intake closely and objectively, track weights, and keep an eye on lab values.
The Registered Dietitian (RD) is Your Go-To: RDs are the primary profession for nutrition monitoring, but as SLPs, we can help by encouraging discussions and working directly with the patient, RD, and medical team to make sure everyone is on the same page.
Slow Down the Train: This process can feel like a heavy train that doesn’t want to slow down, but like any journey, it often requires slowing down to navigate tight turns and get home safely. A systematic approach based on measurements and quantifiable outcomes is the key.
Conclusion
The solution isn't complicated and it doesn't take much extra time, but it can be easy to dismiss. What it comes down to is this: One step back to take two steps forward. As Gramlich & Guenter highlight, reducing harm and maximizing benefit for patients receiving enteral nutrition hinges on careful monitoring throughout the entire process. So let’s keep our eye on the ball and get our patients where they’re trying to go—safely.
What's your biggest challenge in ensuring patients are getting enough nutrition post-tube removal? Share below!
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References
Gramlich, L., & Guenter, P. (2025). Enteral Nutrition in Hospitalized Adults. The New England Journal of Medicine, 392(15), 1518–1530.
McClave, S. A., DiBaise, J. K., Mullin, G. E., & Martindale, R. G. (2016). ACG Clinical Guideline: Nutrition Therapy in the Adult Hospitalized Patient. The American Journal of Gastroenterology, 111(3), 315–334.
McClave, S. A., Taylor, B. E., Martindale, R. G., et al. (2016). Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN. Journal of Parenteral and Enteral Nutrition, 40(2), 159–211.
Vinci, G., Yakovenko, N., De Waele, E., & Stocker, R. (2025). Transition From Enteral to Oral Nutrition in Intensive Care and Post Intensive Care Patients: A Scoping Review. Nutrients, 17(11), 1780.
