Feeding Tube Complications

Basics

Description

Extubation:
- Accidental or intentional
- More common with nasoenteric tubes compared with percutaneous endoscopic gastrostomy (PEG) tubes, gastrostomy tubes (G tubes), or jejunostomy tubes (J tubes)
Occlusion:
- Small diameter:
  - Most common with nasoenteric tubes
- Pill fragments
- Inadequate flushing
- Physical incompatibilities between formula and medications:
  - Adherence of formula residue to inner wall
- Essential to rule out malposition, fracture, kinking, and dislodgment
Peristomal wound infections:
- Risk factors:
  - Malnutrition
  - Stomal leak
  - Local irritation
  - Poor wound care
  - Immunosuppression
  - Diabetes mellitus
  - Poor wound healing
  - Obesity
  - Malignancy
- Excessive traction on tube:
  - Leads to delayed maturation of gastrocutaneous tract
  - Increases stoma leakage
Stoma leak:
- Problematic with distal obstruction (mechanical or dysmotility); more common with high gastric residual
- Excessive tube motion
- More likely to occur in malnourished and diabetic patients
Aspiration pneumonia:
- At risk:
  - Impaired cough/gag reflex
  - Delayed gastric emptying from ileus
  - Obstruction
  - Gastroparesis
  - Gastroesophageal reflux (frequent with large nasoenteric tube)
Diarrhea:
- Medication induced:
  - Antibiotics
  - Promotility agents
- Overgrowth of Clostridium difficile, other bacteria, or Candida
- High osmolar formula
- Hypoalbuminemia
Feeding intolerance:
- High residual suggests GI motility dysfunction
- Delivery is too rapid
- High osmolarity formula
- Lactose or fat intolerance
- Low-serum albumin
Uncommon complications:
- Abdominal wall hematoma
- Fistulas:
  - Hepatogastric
  - Gastrocolic
  - Colocutaneous
- Perforation (usually at time of placement)
- Injury to abdominal organs
- Pressure sores/ulcerations
- GI bleeding:
  - Esophagitis/gastritis, gastric pressure ulcers, concomitant PUD
- Gastric outlet obstruction:
  - Partial or complete obstruction at the pylorus or duodenum by part of tube or Foley catheter balloon used for temporary replacement
- Buried bumper syndrome
  - Rare but potentially serious
  - Bumper becomes lodged between the gastric wall and skin due to gastric ulceration from excessive tension
  - Usually a late complication
- Bowel volvulus around PEG tube

Pediatric Considerations
Increased risk of aspiration:

Delayed gastric emptying
Immaturity of lower esophageal sphincter

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