Unintended Adverse Effects of Enteral Nutrition Support

Pahsini, Karoline; Marinschek, Sabine; Khan, Zahra; Dunitz-Scheer, Marguerite; Scheer, Peter

doi:10.1097/mpg.0000000000000919

Cited by 38 publications

(21 citation statements)

References 35 publications

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“…Not only are parents concerned about the loss of feeding in the face of making a decision about GT placement, but they are also concerned about significant gastrointestinal symptoms that are perceived to be uncomfortable and disconcerting: gagging and retching, vomiting, nausea, and loss of appetite 25 . Previous experiences of the family also need to be reviewed.…”

Section: Discussionmentioning

confidence: 99%

“…20 Not only are parents concerned about the loss of feeding in the face of making a decision about GT placement, but they are also concerned about significant gastrointestinal symptoms that are perceived to be uncomfortable and disconcerting: gagging and retching, vomiting, nausea, and loss of appetite. 25 Previous experiences of the family also need to be reviewed. Recounting frequent episodes of NGT dislodgement and assessment of poor quality of life for them and their child related to this along with oral feeding refusal and poor weight gain may lead caregivers to readily consider GT placement.…”

Section: Parent and Family Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Transitioning From Nasogastric Feeding Tube to Gastrostomy Tube in Pediatric Patients: A Survey on Decision‐Making and Practice

et al. 2020

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Background: Tube feeding via nasogastric tubes (NGTs) and gastrostomy tubes (GTs) is a common practice for children unable to meet their nutrition needs by oral feeding alone. There is currently a lack of evidence-based guidance specific for the process of transitioning from an NGT to GT as a longer-term enteral access device. Uncertainty in the literature about feeding tube choices, practices, and transitions requires clinicians to draw on incomplete and sometimes conflicting evidence, personal experience, economic realities, and compassion to deliver supportive child-centered care. Methods: The ASPEN Enteral Nutrition Task Force Pediatric Work Group designed a survey to explore current practice of enteral access device safety and use among pediatric clinicians practicing in the US and Canada. The survey aimed to define time frames, parameters, and decision points to guide clinicians and families in the transition from NG to GT feeding. Results: 258 clinicians, 55% practicing in an inpatient setting, 17% in-home patient setting, and 28% practicing in both inpatient and outpatient setting. 22% were physicians, 42% were dietitians, 32% were nurses or advanced practice nurses, 2% were pharmacists. The most common feeding tubes used were NGTs followed by GTs. Majority of respondents indicated that they did not have a specific timeline for when an NGT should be changed to a GT. Highest ranked patient factors or clinical considerations prior to recommending changing from an NGT to a GT were exceeding the duration for temporary feeding or the need for an extended duration of tube feeding. Highest physician barriers to GT placement were the reluctance for referral from primary care doctors for GT placement. Majority of respondents reported the use of NGTs for enteral access at home and that parents were taught how to place the NGTs for home use but without consistently being taught the use of pH paper to verify NGT tip location or being provided with the pH paper to perform this task at home. Conclusions: This survey is the first step to address the knowledge gap surrounding feeding tube choices by ascertaining the current standard of practice regarding enteral access devices and appropriate timing of transitioning from NGT to GT feeding. The results highlight current practice variability and concerns. Information from the survey was used to formulate a decision tree to guide the transition of NGT to GT feeding that nutrition support professionals can use to advocate for best practices in their hospital and community settings.

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Section: Discussionmentioning

confidence: 99%

Section: Parent and Family Factorsmentioning

confidence: 99%

Transitioning From Nasogastric Feeding Tube to Gastrostomy Tube in Pediatric Patients: A Survey on Decision‐Making and Practice

et al. 2020

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“…However, regardless of their disease, patients on enteral nutrition often show a series of "secondary" symptoms that can be described as gastrointestinal tract reactions to diet administration, including: pain, discomfort, gastric residual volume, delayed gastric emptying, abdominal bloating and cramps, nausea/vomiting, diarrhea [1,4,8,9,12,20,22,32,[33][34][35][36][37][38][39], metabolic disorders [1,12], and, when the enteral nutrition is longer term, ulcers and major weight loss [33,34]. In addition, some patients are unable to tolerate enteral nutrition [9,22], especially pediatric patients [38,39].…”

Section: Problems Associated With Enteral Nutritionmentioning

confidence: 99%

Enteral Feeding: Brain-Visceral Interactions in the Processing of Nutrients

Palma¹,

Mahía²,

Simon³

et al. 2019

Feed Your Mind - How Does Nutrition Modulate Brain Function Throughout Life?

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Enteral nutrition is often mandatory, especially for patients in vegetative or minimally conscious state. However, its application is nonviable in certain cases due to various adverse effects. Some of these are explained by absence of the cephalic phase of digestion, during which exocrine, endocrine, and motor physiological responses prepare the digestive system to receive, digest, transform, and utilize ingested nutrients. These responses result from the stimulation by nutrients of cephalic sensory systems, mainly in the oropharyngeal cavity, and can also be elicited by food-related thoughts or expectations. The digestive system appears able to rapidly assess the suitability of food and transmit this information to the brain. The vagus nerve and its brainstem relays in the caudal nucleus of the solitary tract (NST) and parabrachial complex appear to participate in the anatomic pathway responsible for this rapid processing. Thus, blockade of the vagus nerve, NST, or external lateral parabrachial region (LPBe) interrupts expression of conditioned taste preferences induced by administration of "predigested" food, while LPBe activation by electric stimulation generates similar preferences to those observed after cephalic food administration. This review may help design enteral diets better adapted to digestive physiology and develop pharmacological interventions against adverse effects of enteral nutrition.

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“…Long‐term dependence on an EAD is associated with untoward events that affect the child's quality of life. One study looked at adverse events associated with EAD use in 425 infants and children, of whom 44% required NG and 56% required G tube feedings 70 . Of this cohort, 56% of the children exhibited gagging and retching, 50% vomited often, and 45% had anorexia.…”

Section: Unintended Consequences Of Ead Usementioning

confidence: 99%

Pediatric Enteral Access Device Management

2016

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Enteral nutrition (EN) support has proven to be a nutrition intervention that can provide full or partial calories to promote growth and development in infants and children. To supply these nutrients, an enteral access device is required, and the use of these devices is growing. Placement of the proper device for the patient need, along with appropriate care and monitoring, is required for individualized patient management. When complications arise, early identification and management can prevent more serious morbidity. Complication management requires a tiered approach starting with staff nurses and ending with a physician expert. In addition to this, each institution needs to have an approach that is coordinated among disciplines and departments to promote consistency of practice. The formation of an enteral access team is a conduit for clinical experts to provide education to families, patients, and healthcare professionals while serving as a platform to address product and practice issues.

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Unintended Adverse Effects of Enteral Nutrition Support

Cited by 38 publications

References 35 publications

Transitioning From Nasogastric Feeding Tube to Gastrostomy Tube in Pediatric Patients: A Survey on Decision‐Making and Practice

Transitioning From Nasogastric Feeding Tube to Gastrostomy Tube in Pediatric Patients: A Survey on Decision‐Making and Practice

Enteral Feeding: Brain-Visceral Interactions in the Processing of Nutrients

Pediatric Enteral Access Device Management

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