Feeding Tube Placement

Abstract

Feeding tube placement for enteral nutrition (EN) support is widely used in both critically ill and stable chronically ill patients who are unable to meet their nutrition needs orally. Nasal or oral feeding tubes can be performed blindly at the bedside or with fluoroscopic or endoscopic guidance into the stomach or small bowel. Percutaneous feeding tubes are used when EN support is required for longer periods (>4-6 weeks) and are most commonly placed endoscopically or radiographically. Although generally safe and effective, there is a wide spectrum of known complications associated with feeding tube placement. Errors made at the time of feeding tube placement can result in a number of these procedural and postprocedural complications. In many cases, a single error at the time of placement can result in numerous complications. A thorough knowledge of these errors and avoiding them in practice will decrease iatrogenic complications in a vulnerable population. In addition, early recognition and management of complications will further minimize morbidity and even mortality in enteral feeding tube placement. This article reviews the common errors leading to complications of enteral feeding tube placement and their prevention and management.

Blind bedside postpyloric placement of spiral tube as rescue therapy in critically ill patients: a prospective, tricentric, observational study

“…All these suggested that the current method represented a minimally invasive technique. Even though a low, even zero, complication rate was reported [ 23 – 27 ], severe complications [ 23 , 36 , 37 ] should be cautioned against due to the nature of the unguided nonvisual technique.…”

Electromagnetic Sensor-Guided Enteral Access Systems: A Literature Review

“…Radiographs are only accurate at the time they are taken and additional radiographs may be required if the nasoenteric tube is clinically suspected of moving from the initial placement following, for example, coughing, retching or vomiting. For instance, between 27 and 42 % of NJ tubes show retrograde migration into the duodenum or stomach [16], while NG tubes can move to the oesophagus or post-pylorically. Repeated X-ray exposure carries a small, but appreciable, carcinogenic risk.…”

Outcomes and Safety Issues Related to Percutaneous Endoscopic Gastrostomy in Neurodegenerative Diseases

“…A colo-cutaneous fistula is a rare complication, and it occurs when the colon is accidentally punctured during guided needle puncture for initial gastrostomy placement. It seldom occurs due to internal bump-induced erosion into the adjacent colon over time [3,5]. Second, the entire procedure should be performed under aseptic conditions.…”

“…A skin incision of the proper length should be made on the abdominal wall with a knife for easy passage of the gastric tube into the stomach cavity. Aspiration can be prevented by frequent intra-procedural suction of the oral cavity, placing the patient in the left lateral position, and avoiding excessive air insufflation.The tube site should be kept clean, and the external bolster should be carefully secured to avoid inadvertent tube removal [2,5]. The stoma tract usually matures within 7–14 days after initial gastrostomy [2,5].…”

“…Aspiration can be prevented by frequent intra-procedural suction of the oral cavity, placing the patient in the left lateral position, and avoiding excessive air insufflation.The tube site should be kept clean, and the external bolster should be carefully secured to avoid inadvertent tube removal [2,5]. The stoma tract usually matures within 7–14 days after initial gastrostomy [2,5]. To avoid inadvertent removal of the gastric tube, physicians should be particularly careful in patients with arm movement and mental confusion.…”