Enteral tube feedings may be necessary for patients who have a working gastrointestinal system but are unable or unwilling to ingest food orally. Medical conditions in which enteral feedings may be useful include severe anorexia, liver failure, head or neck trauma or cancers, severe malnutrition or coma. Types of enteral feeding tubes include nasogastric, gastrostomy and jejunostomy tubes. Nasogastric tubes are inserted through the nose and threaded down the throat and into the stomach while gastrostomy and jejunostomy tubes are surgically inserted through the outside of the abdomen into the stomach or small intestines. Complications of tube feeding may require a change in how feedings are administered or even a replacement of the tube.
Aspiration
Aspiration occurs when some of the feeding, or gastric contents, refluxes into the esophagus and is inhaled into the lower airways. Some signs of aspiration may include vomiting, coughing, change in breathing pattern, difficulty breathing or the development of aspiration pneumonia. Aspiration pneumonia is a lung infection caused by inhaling oral secretions, liquid feeding or gastric contents. Risk factors for aspiration include advanced age; active esophagitis, or inflammation of the esophagus; history of acid reflux; impaired level of consciousness; poor oral hygiene; history of aspiration; or sedative medications. Insuring proper feeding tube placement and sitting in an upright position during and for 30 minutes after a tube feeding may help decrease the chances of aspiration.
Gastrointestinal Complications
Tube feedings can lead to such gastrointestinal side effects as nausea, vomiting, diarrhea, stomach pain and bloating. Management of gastrointestinal side effects may include trying different brands or flavors of liquid feeding, running the tube feeding at a slower rate if the feeding is continuous or giving the feeding over a longer period of time if the feeding is given as a bolus. The amount of liquid feeding given at one time may also need to be adjusted to decrease gastrointestinal side effects.
Metabolic Complications
Metabolic complications include changes in blood chemistry and electrolyte levels. Two possible electrolyte problems include high blood sugar level and low sodium level. Tube feedings may cause high blood sugar levels because the high calorie liquid feeding may reveal underlying diabetes or glucose intolerance. Low sodium levels may arise from too much free water flushing of the tube before and after a feeding. Anyone taking enteral tube feedings should have his blood electrolyte levels checked frequently by a physician.
Mechanical Complications
Complications due to enteral tube feedings may arise due to clogged or displaced feeding tubes. The position of any feeding tube should be confirmed by an X-ray prior to initiating any feedings. Once placement is confirmed, any accidental pulling or catching of the tube should be reported to a physician immediately so placement can be reconfirmed. Poor tube placement can lead to infections in the lungs or abdominal cavity. Proper tube maintenance is necessary to prevent tube clogging. Specific instructions should be given regarding how to care for the tube, when to flush the tube with water and how much water to use. Tubes that become clogged may need to be replaced if a doctor is unable to unclog them.
