Tuesday, December 9, 2014

on rectal feeding

From Dudrick and Palesty (2011, my emphasis),
 In 1910, Max Einhorn used his “duodenal pump,” a tube with a metal capsule on the end (which was usually used for sampling duodenal content) to introduce milk, eggs, sugar, and water directly into the duodenum in patients who could not be fed by mouth or stomach. He also vigorously condemned rectal feeding because of the high incidence of rectal irritation and the poor absorption of the nutrients.
 The efficacy of rectal feeding was debated in the nineteenth century (Harkness 2002).

Einhorn's "duodenal pump" minimized feeding intolerance and rectal feeding fell out of favor, although administration of water, saline, and glucose rectally continued until 1940. Gresci and Mellinger (2006) describe numerous bedside placement methods dating back to the sixteenth century,
In the 1790s, Hunter described the use of a hollow tube introduced into the stomach for feeding. He successfully treated a patient with paralysis of the muscles of deglutition by using a tube made of a whalebone probe covered with an eel skin and attached to a bladder. The eel skin–covered probe was placed orogastrically, and the suggested feedings were jellies, whipped eggs, sugar, milk, or wine.

Which is to say, the rectum should not be considered a serious route of administration for enteral feeds. And yet,

Einhorn would not be surprised.