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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