5 Common Feeding Tube-related Complications and their Solutions

1. 5 Common Feeding Tube-related Complications and their Solutions Enteral feeding techniques have always been challenging for the patients and the caregivers. The objective of enteral feedings is to provide nourishment to the patient through a tube inserted directly into the gastrointestinal (GI) tract. Feeding tubes are used for patients who have a functional GI tract but cannot take foods orally to fulfill their daily nutritional needs. Depending upon the person’s health conditions, the feeding tube may be placed either temporarily or permanently throughout a lifetime. The gastroenteric tube is vital in managing critically ill patients and has a poor voluntary intake. However, despite the multiple benefits, caregivers face various problems and complications while feeding patients via feeding tubes. But most of these problems have solutions, and this article discussed them in detail.

2. The Common Complications Associated with the Feeding Tube There can be multiple feeding tube-related complications, and most of them can be resolved if identified at the right time. 1. Aspiration - Enteral tube feedings may cause pulmonary aspiration, when foods, liquids, or other foreign substances are breathed into the lungs. In other words, aspiration occurs when food and drinks pass through the wrong tube - that’s the trachea or the windpipe. The Solution: Studies show that the chances of aspiration are high with patients feeding through enteral tubes. To reduce aspiration risks, monitor the patient during continuous tube feedings. Also, monitor the GRV (gastric residual volume) every 4 hours (or as advised by the doctor). You may need to pause the tube feedings for patients with high GRVs, such as above 500 ml, unless they have other risk factors or show intolerance symptoms. You can also try repositioning the patient by keeping the head of the bed at an elevation of 30-degree or higher. This will prevent any risks of aspiration arising out of reflux. If the patient has a high aspiration risk, you may turn off the feeding tube while repositioning or transporting the patient. 2. Refeeding Syndrome - Refeeding syndrome occurs when the patient shows signs of metabolic abnormalities while fed via feeding tubes after a long period of malnourishment or starvation. A starved person may suffer losses of certain electrolytes, including potassium, phosphate, and magnesium. These feeding shifts may even be fatal as major modifications in body fluids and electrolytes can result from metabolic and hormonal changes. Some symptoms of refeeding syndrome include - ● Fatigue ● Breathing difficulties ● Weakness ● High blood pressure ● Irregular heartbeat ● Seizure ● Edema ● Confusion

3. The Solution: Monitor the patient’s intolerance levels at the beginning of enteral feedings. Check the person’s heart rate, heart rhythm, and electrolyte levels. You may provide vitamin and mineral supplements to avoid the risks of nutrient deficiencies. 3. Tube Misplacement or Malpositioning - Misplaced or dislodged feeding tubes may cause bleeding and even perforations in the GI tract, the trachea, and the parenchyma. The Solution: Feeding tubes must be inserted only by professionally trained personnel, and the position must be confirmed radiographically. Examine feeding tube integrity before every shift in the patient’s positions. Look for signs like insertion-site Infections and increase in blood pressure, agitation, heart rate, and restlessness. Verbal patients may also complain about pain near the feeding tube site. Take necessary actions either by changing the tube positions or halting feedings in high-risk cases. 4. Medication-related Problems - Patients fed with enteral tubes may suffer from diarrhea due to feeding intolerance and malabsorption. However, some recent studies have revealed that certain medications, like those with high sorbitol levels, may also be the reason. The Solution: Remember that certain medications need to be given on an empty stomach. You may also need to withhold tube feedings for about an hour or two before and after medications. Some medications may cause clogging in the feeding tube, especially if crushed. You need to check potential clogs in the enteral tube and manage effective tube flushing and maintenance. 5. Fluid Imbalance - Improver tube flushings may cause fluid overload or imbalance. Most patients need these free-water flushes to prevent dehydration. Besides, clogged tubes may not allow the fluid to pass down the GI tract. The Solution: Make sure the patient gets around 30 ml/kg of water every day through I.V. hydration or free-water flushes. Water flushes are needed before and after medications depending on the nature and properties of the drug.

4. Nursing Care Tips The nursing professionals should thoroughly assess the patient before using enteral feeding tubes. Closely monitor the patient during the feedings and resolve the above techniques if you face challenges. The role of a nurse would be to ensure that the patient doesn’t suffer from malnutrition due to improper or irregular feeding schedules. Malnourished patients may suffer from other problems like poor healing, emaciation or weight loss, and pressure injuries. So, ensure that the patient gets the right amount of proteins and other essential nutrients every day.