disorders of nutrition
Tube Feeding
Complications of Tube Feeding
Complications of tube feeding are common and can be serious. Problem Possible Effects Comments Tube-related Tube-related Presence of the tube in the nose or mouth Discomfort Damage to the nose, throat, or esophagus Sinusitis None A tube in the nose or mouth, particularly if large, can irritate tissues, causing pain and sometimes bleeding. In such cases, the tube is usually removed, and feedings are continued with a different kind of feeding tube. Sinuses can become blocked, making infections (sinusitis) more likely. Incorrect placement of the tube inserted through the nose or mouth Damage to the affected area Coughing and gagging Overview of Pneumonia None Rarely, a tube in the nose or mouth goes down the airways rather than the esophagus. As a result, food can enter the lungs. When the tube is placed in the airways, people who are conscious and alert cough and gag. Incorrect replacement of a tube previously placed directly into the stomach or intestine Peritonitis None When a tube shifts out of place, it must be removed and placed again. If the tube was originally inserted directly into the stomach or intestine, reinserting the tube is more difficult, and the tube may be placed outside the digestive tract. Then food can enter the space around the abdominal organs (abdominal cavity). As a result, the membrane that lines that space may become infected—a serious infection called peritonitis. Blockage of a tube Inadequate nutrition Thick formulas or pills can block a tube. Sometimes doctors can dissolve the blockage by adding certain enzymes or substances formulated to break foods down. Accidental expulsion of a tube Inadequate nutrition Tubes often come out accidentally. If a tube is still needed to provide nutrition, it must be replaced. Formula-related Formula-related Intolerance of the formula Diarrhea, digestive upset, nausea, and vomiting The formula causes intolerable digestive symptoms in up to 20% of people being fed through a tube and in 50% of those with a serious illness. These symptoms are more common when feedings are given in large amounts (called boluses) given several times a day rather than continuously over longer periods of time. Diarrhea Frequent, loose stools Many formulas used in tube feeding containsorbitol, which can cause or worsen diarrhea. When diarrhea occurs, many of the nutrients pass through the digestive tract without being absorbed. Imbalances in nutrients Abnormal levels of Overview of Electrolytes None Abnormally high levels of blood sugar (hyperglycemia) Too much fluid in the body (volume overload) Doctors regularly measure weight (to check for too much water) and blood levels of electrolytes, sugar, and other substances. They then adjust the formula as needed. Other Other Backward flow of the stomach's contents into the esophagus (reflux) Excess secretions in the mouth and throat Inhalation (aspiration) of the formula into the lungs, which causes coughing and choking and increases the risk of infection such as pneumonia If people have either of these problems, they may inhale the formula into the lungs even though the tube is placed correctly and the head of the bed is elevated. 