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Complications & Risks

Some health problems or symptoms happen more often in people with feeding tubes than in people without feeding tubes. We can help you understand the impact of these complications and risks.

Constipation

Constipation can occur for a number of different reasons; for people with feeding tubes, this is typically due to lack of fiber within the formula or poor hydration.

Dehydration

When you get most of your nutrition and fluids through a feeding tube, it can be easy to become dehydrated. Hydration is often overlooked since feeding tubes primarily focus on caloric intake. Even though formula is in a liquid form, not all of that is water. Keeping proper hydration while tube feeding requires care and monitoring.

Diarrhea

Diarrhea is a common issue for individuals receiving tube feeding, and it can be caused by several factors. Here are some key points to consider:

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Potential Causes

  1. Medications: Certain medications, especially those in liquid form, can contribute to diarrhea due to their high osmolality

  2. Infections: Gastrointestinal infections can irritate the intestines and lead to loose stools.

  3. Formula Contamination: Improper handling and storage of feeding formulas can cause contamination, leading to diarrhea

  4. Feeding Rate: Administering the feeding too quickly can overwhelm the digestive system.

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Management Strategies

  1. Adjust Feeding Rate: Slowing down the rate of tube feeding can help manage diarrhea

  2. Medication Review: Consult with a healthcare provider to see if any medications could be contributing to the issue and if alternatives are available

  3. Hygiene Practices: Ensure proper handwashing and equipment cleaning to prevent contamination

  4. Formula Choice: Switching to a fiber-containing formula or adding a soluble fiber product can help form more solid stools

  5. Probiotics: These can be effective in treating diarrhea and maintaining gut health.

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When to Seek Medical Advice

  • If diarrhea persists for more than 24 hours.

  • If there is blood in the stool.

  • If severe abdominal pain occurs

Skin Issues

Tube feeding can cause several skin issues, including

  • Stomal enlargement

  • Leakage

  • Skin breakdown

  • Hyper granulation tissue

  • Pressure necrosis

Perforations

Perforations in tube feeding patients can occur due to various reasons, often related to the placement and management of the feeding tubes. Here are some key points:

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  1. Causes: Perforations can happen during the insertion of the tube, especially if the procedure is not done carefully. This can lead to esophageal, gastric, or intestinal perforations

  2. Symptoms: Common symptoms include severe abdominal pain, fever, and signs of infection or sepsis. In some cases, patients may also experience difficulty breathing or swallowing

  3. Management: Early recognition and prompt management are crucial. Treatment often involves surgical repair of the perforation and antibiotics to prevent or treat infection

  4. Prevention: Using proper techniques during tube insertion and ensuring the tube is correctly positioned can help reduce the risk of perforations. Regular monitoring and care of the tube site are also important

Infections

Infections related to tube feeding can occur due to various reasons:

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  • Poor cleaning of the feeding tube or a loose-fitting tube around the stoma.

  • Symptoms of infection include redness, inflammation, pain, sensitivity, and oozing of blood or pus.

  • Risk factors include age, compromised nutritional intake, immunosuppression, underlying diseases, and prior chemotherapy or radiotherapy.

  • Peristomal infections are generally mild and can be controlled with local therapy.

Displacement

Patients may accidently pull at an NG or nasointestinal tube, causing displacement rather than complete tube removal. As with dislodg-ment, patient activity and transport can cause tube displacement. So can coughing and gagging. To detect displacement, monitor tube distance outside the patient.

Obstruction

If no contents are expelled, flush the tube with water to ensure it is not obstructed. Some tubes have valves, like buttons, that can make them challenging to empty. Should the tube be clogged, or if you're unable to drain the stomach or release gas, contact your doctor to discuss options for decompression tubes or devices.

Aspiration

Aspiration happens when substances like stomach contents, saliva, food, or secretions from the nose and throat are breathed into the airways or lungs. Not all instances of aspiration lead to pneumonia. While micro-aspiration is frequent and rarely leads to lung issues in healthy individuals, hospitalized patients face a higher risk of respiratory problems and pneumonia after aspiration due to reduced consciousness, compromised airway protection, and weakened immune response. Aspiration can be symptomless or manifest with signs such as coughing, choking, and sudden respiratory distress.

Medication-related Complications

Clogging from medications or enteral formula is the most common cause of tube malfunction, with an incidence of 25% to 35%. Prevention strategies include the following:

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  • avoid bulking agents through the tube

  • flushing with water before and after administering feeds and medications

  • use of only water-soluble or liquid medications.

 

If blockage occurs, warm water flushes are the best irrigate. Alternatives include soda and pancreatic enzymes dissolved in bicarbonate solution. Mechanical devices such as an endoscopy channel cleaning brush or endoscopic catheters also have been used.

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