Tube feeding types
Tube feeding is conducted in case of damaged gastrointestinal tract. Patients by feeding tubes are receiving enternal nutrition. It is generally used in the LTC patients.
Nasogastric, nasoduodenal and nasojejunal are used for nasoenternal tube feeding. These are applied when patients can’t eat for longer period of time. The feeding tubes can be inserted surgically, by computed tomography and in the percutaneous endoscopic gastronomy (PEG) procedure. Jejunal feeding tube extension (jejunostomy) can be added to existing PEG for patients that need prolonged enternal feeding, have chronic aspiration, stomach disease or previously had gastrectomy.
Complications of tube feeding may include:Aspiration pneumonia- leading cause of death (5-58%). Presence of aspiration pneumonia is characterized by respiratory difficulties or pneumonia. Age, esophagitis on endoscopy, history of pneumonia or aspiration, gastroesophageal reflux, narcotic medications and neurological disorders are the risk factors. Aspiration pneumonia can be prevented if patients are fed while sitting or at 45 degree body position. Oral care and primotility medications can reduce aspiration pneumonia risk.Gastrointestinal complications: 1) Diarrhea. Can occur due to formula of infusion or its rate, bacterial impact, infection, medications (containing sorbitol, magnesium, antibiotics, H2 blockers etc), 2) Nausea, vomiting and abdominal bloating. Abdominal bloating can occur because of excessive feeding rate, postponed gastric emptying and reduced bowel motion. Nausea may be the result of abdominal bloating and cramps.Metabolic complications. These complications can take place if serum levels of potassium, magnesium, sodium, phosphorus, zinc, copper and vitamins are either high or low. Hyperglycemia, as another metabolic complication, occurs in 10-30% of patients due to overfeeding, acute illness and low insulin. Refeeding syndrome can be present in chronic alcoholics, anorectics, malnourished patients and those that receive infusion without nutrients. One of the symptoms is hypophosphatemia that induces cardiac, respiratory, gastric and renal disorders. Mechanical complications. Insertion of tube carries the risk of perforation, rhinitis, intracranial and bronchial insertion. Position of feeding tube should be radiologically determined. Nasoenternal tubes can cause abscess, sinusitis, nasal erosion, hoarseness and sore mouth. Since the tube can be accidentally pulled out, it should be fixed with tape since the removal may include certain problems. Leakage of tube is also very common and may cause skin abrasion and severe hygiene problems. Feeding tubes can often block and can be prevented by regular flushing with water or certain solutions.Complications due to drug-enternal feeding. May happen because of interaction between prescribed medications and enternal feeds, hence these two must be separately administered.