Complications

The potential complications of EN are:

• feeding-tube related: malposition, unwanted removal, blockage;

• diet and diet administration related: diarrhoea, bloating, nausea, cramps, regurgitation, pulmonary aspiration, vitamin, mineral, trace element deficiencies, drug interactions;

• metabolic/infective;

• infective: diet, reservoirs, giving sets.

Tube blockage most commonly occurs after disconnection of the giving set from the feeding tube when the residual diet solidifies. This complication may be prevented by flushing the tube with water after disconnection.

Diarrhoea occurs in about 10% of patients. Its aetiology is multifactorial with a strong association with concomitant antibiotic therapy, and hypoalbuminaemia may have a role. Symptomatic treatment (with antidiarrhoeals such as codeine phosphate or loperamide) is appropriate and only rarely does enteral feeding have to be discontinued.

Figure 4.3. A needle catheter jejunostomy. This may be performed at the conclusion of the main operation. (a) A needle of the central venous catheterization type is inserted obliquely through the antimesenteric border of the jejunum about 15 cm distal to the ligament of Treitz. (b) A 30 cm, 16 gauge catheter is advanced about 10-15 cm into the lumen, the needle withdrawn and the catheter secured in place with a single 4, 0 silk purse string suture. (c) The needle is then passed into the abdomen from the skin surface and the extraluminal portion of the catheter is passed through the needle to the outside. (d) The catheter is secured to the skin and the jejunum tacked to the anterior parietal peritoneum of the abdominal wall.

Figure 4.3. A needle catheter jejunostomy. This may be performed at the conclusion of the main operation. (a) A needle of the central venous catheterization type is inserted obliquely through the antimesenteric border of the jejunum about 15 cm distal to the ligament of Treitz. (b) A 30 cm, 16 gauge catheter is advanced about 10-15 cm into the lumen, the needle withdrawn and the catheter secured in place with a single 4, 0 silk purse string suture. (c) The needle is then passed into the abdomen from the skin surface and the extraluminal portion of the catheter is passed through the needle to the outside. (d) The catheter is secured to the skin and the jejunum tacked to the anterior parietal peritoneum of the abdominal wall.

Antibiotics that are no longer clinically indicated should be stopped. Nausea and vomiting rarely occur and may result from slowed gastric emptying. Antiemetics may be of benefit. The symptoms of bloating, abdominal distension and cramps most commonly occur following inadvertent too rapid administration of feed and are very similar to the symptoms described in association with bolus-type feeding. Enteral diets will interact with enterally administered drugs (e.g. theophylline, warfarin, methyldopa and digoxin). Failure of drug therapy in previously stable patients receiving EN support must be assumed to be feed related until proven otherwise.

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