Risk Factors With Feeding Tubes

Types of Feeding Tubes

There are several tube feeding options available when the time for nutritional assistance is needed. Feeding tubes can be temporary or permanent. Nasal tubes are generally short-term, while long-term tubes are inserted directly into the neck, stomach or abdomen. Depending on the type of tube inserted, some feeding tubes require surgical insertion, such as with the gastrostomy (tube in stomach) or jejunostomy (tube in small intestine.)

Feeding tubes are indicated for individuals already experiencing swallowing difficulties and/or choking, which is why they must be carefully inserted, properly monitored, and given meticulous care. Improper placement can lead to a variety of complications one of which can be deadly: aspiration.

Aspiration occurs when foreign material, such as food, drink, saliva or stomach contents is inhaled into the lungs. This foreign substance introduces abnormal elements into the delicate respiratory system causing the lungs to respond with an immune response called pneumonia, also known as aspiration pneumonia.
Along with ensuring proper placement of the feeding tube, additional measures can be put in place to minimize the chance of aspiration. These actions involve carefully measuring how much the patient is digesting to prevent over-feeding and keeping the head of the bed at or above 30 degrees.

When inserting a feeding tube through the nose, the rare but potentially life-threatening complication of puncturing the esophagus or stomach can occur. This is a particular concern when inserting feeding tubes in preterm infants due to their delicate digestive structures. Careful insertion by trained professionals along with careful monitoring after insertion will help minimize such complications.

The nasal mucosa is rather delicate and easily irritated. Insertion of a firm feeding tube can inflame the nose and throat causing bleeding and discomfort. For this reason, nasal tubes are recommended as only short-term options. Removal as soon as possible is top priority, even if placement of a more permanent tube into the stomach or intestines is required. Bleeding risks associated with nasal feeding tubes are of particular concern in patients with bleeding disorders. Careful monitoring for bleeding is a must in such cases.

No matter the age of the patient, nasal feeding tubes can obstruct breathing passages to a variety of degrees ranging from minor to significant. While an adult who is short of air may feel anxious with a feeding tube blocking one nasal passage, significant oxygen depletion is a major concern in newborn infants with much smaller anatomy. As the young and potentially weak infant works to breath around the nasal obstruction, they can eventually tire to the point of respiratory distress. An oral tube can be passed through the infant's mouth, but the risk of it coiling in the mouth or creating slow respirations from vagal nerve stimulation is a continual threat. Once again trained personnel are key to safe administration of nutritional supplements via a feeding tube.

There are different ways to check for proper placement once a feeding tube is inserted. A carbon dioxide detector can be placed at the opening of a newly inserted tube to detect CO2, which would indicate improper positioning in the lungs. The caregiver can also attempt to pull back fluid from the feeding tube. If fluid is obtained it can be checked for an acidic pH, which would point to proper placement in the stomach. This, however, is still no guarantee. The only way to begin tube feedings with the assurance the tube is in the stomach and not lungs is through a chest X-ray. This is the most common and conclusive way to ensure feeding can begin without harm to the patient.