Herndon, in Total Burn Care (Fifth Edition), 2018 Complications of Nutritional SupportĬomplications of nasogastric and enteric feeding include nausea and vomiting, epistaxis, sinusitis, nasal necrosis, aspiration leading to pneumonia, tube malpositioning, dislodgment, and feeding-associated diarrhea. (2010) found that the median survival of PEG patients was 753 days, and the most frequent cause of death was pneumonia (59%). (1998) carried out a retrospective population-based descriptive study employing 81,105 Medicare beneficiaries (aged > 65) who received PEG tube placement and found that the overall mortality rate at 30 days was 23.9%, reaching 63.0% at one year and 81.3% by three years. High incidences of chest infection and death are each associated with both methods of tube feeding ( Dennis et al., 2005 Grant et al., 1998 Ickenstein et al., 2005). Stroke is indeed the primary cause of PEG tube placement ( Grant et al., 1998 Suzuki et al., 2010), but there is no clear evidence to suggest that one route is more beneficial than any other in stroke patients. Nonoral or tube feeding (nasogastric tube and PEG tube placement) has become a well-established clinical practice in stroke patients who are dysphagic and at high risk for aspiration or who cannot meet their nutritional needs orally. Hideaki Takahata, in Bioactive Nutraceuticals and Dietary Supplements in Neurological and Brain Disease, 2015 Nonoral Feeding This can be successful even in patients with relatively high gastric aspirates, previously thought to be a contraindication for feeding via the enteral route. More recently, double-lumen tubes have been used – one lumen resides in the stomach and is used to aspirate gastric contents, while the distal lumen is placed in the jejunum for feeding, thus reducing risks of aspiration. Oesophageal necrosis, stricture formation
Other complications associated with the use of nasoenteric tubes include: In the latter patients, the fine-bore tube can be manipulated through the pylorus into the duodenum, reducing the risk of gastric aspiration. This is most likely in patients with impaired gastric motility. There has been considerable debate as to whether positioning the feeding tube beyond the pylorus into the duodenum will result in reduction in the risks of regurgitation of gastric contents and pulmonary aspiration (occurs in up to 30% of patients fed this way). Nasogastric feeding via fine-bore tubes (polyvinyl chloride or polyurethane) may be used in patients who require nutritional support for a short period of time. If nasoenteric feeding is required for more than 30 days, access should be converted to a percutaneous one. The benefits of nasoenteric feeding tubes are limited by clogging, kinking, inadvertent displacement or removal, and nasopharyngeal complications. Furthermore, the risks of aspiration pneumonia can be reduced by 25% with small bowel feeding compared with nasogastric feeding. Small bowel feeding is more reliable for delivering nutrition than nasogastric feeding. Similarly, endoscopy-guided placement past the pylorus has a high success rate, but advancing the tube beyond the second portion of the duodenum by a standard gastroduodenoscope is difficult. Fluoroscopy-guided intubation past the pylorus has a greater than 90% success rate and more than half of these intubations result in jejunal placement. Furthermore, it is time-consuming, and the success rate of intubation past the duodenum into the jejunum by these methods is less than 20%. However, the successful placement of feeding tubes by these methods is highly variable and operator dependent. Several methods have been recommended for the passage of nasoenteric feeding tubes into the small bowel, including prokinetic agents, right lateral decubitus positioning, gastric insufflation, tube angulation, and clockwise torque. Radiographic confirmation is usually required to verify the position of the nasogastric feeding tube. Blind insertion of nasogastric feeding tubes commonly results in misplacement, and air instillation with auscultation is inaccurate for ascertaining proper positioning. Nasojejunal feedings are associated with less pulmonary complications, but access past the pylorus requires greater effort to accomplish. Indeed, even in intubated patients, nasogastric feedings can often be recovered from tracheal suction. Nasogastric feeding should be reserved for those with intact mental status and protective laryngeal reflexes to minimize risks of aspiration.
Ziegler, in Encyclopedia of Human Nutrition (Second Edition), 2005 Nasoenteric tubes
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