Adverse Effects of Non Oral Enteral Feeding

While placement of enteral feeding tubes is often taken for granted on a clinical hospital unit, complications are possible. These complications can be associated with placement itself, the mechanical effects of the tube once it has been placed, and the effects of the nutritional supplements themselves. Placement and mechanical complications, while unusual, include head and neck trauma (e.g., bleeding, infection, sinus perforation), inadvertent intubation of the tracheobronchial tree, esophagitis and esophageal stricture, and several issues related to dysfunction of these generally small caliber tubes. Many of these problems are not seen with gastrostomy or jejunostomy. However, the surgical or endoscopic procedures needed to place these tubes, while safe, have a small but measurable risk, primarily infection and, rarely, even death.

Regardless of delivery route, diarrhea and aspiration are the two most common problems that can occur when tube feeding is begun. In hospital patients, diarrhea and often incontinence occur in 25 percent of patients on general units and as many as 65 percent of patients in critical care units. The feeding solutions themselves are responsible for many of these cases. The problem is likely less in nursing homes and patients cared for at home. In most cases, instilling feeding solutions into the stomach, duodenum, or jejunum probably has little impact on the likelihood of aspiration, although reports are conflicting. Upper airway secretions are a more important variable in the risk for aspiration.

Sometimes adding to the suffering burden in dementia patients is the common need for restraints in patients with enteral feeding tubes. Restraining patients is often viewed as humiliating and demeaning, their dementia notwithstanding. In PVS patients, while pain and suffering are not experienced, indirect adverse effects such as incontinence and the requirement for diapers may jeopardize individual dignity.

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