The Selection and Care of Enteral Feeding Tubes
The Selection and Care of Enteral Feeding Tubes
The Selection and Care of Enteral Feeding Tubes
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<strong>Enteral</strong> <strong>Feeding</strong> Tube Decision Tree<br />
Short Term<br />
Less than 3 to 4 weeks<br />
No Aspiration Risk or<br />
Gastric Problems<br />
Nasogastric Tube<br />
<strong>Enteral</strong> Nutrition Needed<br />
Long Term<br />
Greater than 3 to 4 weeks<br />
Nasoenteric Tube Enterostomy Tube<br />
Aspiration Risk or<br />
Delayed Gastric<br />
Emptying<br />
Nasoduodenal or<br />
Nasojejunal Tube<br />
No Aspiration Risk<br />
or Gastric Problems<br />
Gastrostomy Tube<br />
Guenter, P., Silkroski, M. 2001. <strong>Enteral</strong> <strong>Feeding</strong> Access Devices. Tube <strong>Feeding</strong> Practical Guidelines <strong>and</strong> Nursing Protocols.<br />
Aspiration Risk or Delayed<br />
Gastric Emptying [patient<br />
condition dependent ]<br />
Jejunostomy or<br />
Combined<br />
Gastrostomy-<br />
Jejunostomy<br />
Nasoenteric Tube Complications<br />
Sinusitis<br />
Epistaxis<br />
Dysphasia<br />
Dislodgement<br />
Tube occlusion<br />
Pulmonary aspiration<br />
Nasopharyngeal discomfort<br />
Erosion <strong>of</strong> the nasal septum<br />
Migration <strong>and</strong> displacement<br />
Iyer, K.R., Crawley, T.C. Complications <strong>of</strong> <strong>Enteral</strong> Access. Gastrointestinal Endoscopy Clinics <strong>of</strong> North America, 17 (2007) 717-729.<br />
Enterostomy Tube Complications<br />
Infection<br />
Pressure necrosis/ulcers<br />
Skin irritation/breakdown<br />
Excessive granulation tissue<br />
Peritubular allergic reactions<br />
Tube deterioration<br />
Tube occlusion<br />
Tube displacement<br />
Guenter, P. tube Chap 7. 2001. tube <strong>Feeding</strong>: Practical Guidelines <strong>and</strong> Nursing Protocols. CREST. April 2004. Guidelines for the Management <strong>of</strong> <strong>Enteral</strong> Tube <strong>Feeding</strong> In Adults.<br />
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Complications<br />
Associated with<br />
<strong>Enteral</strong> <strong>Feeding</strong><br />
<strong>Tubes</strong><br />
Nasoenteric Tube Complications<br />
Nasoenteric feeding<br />
tubes should NOT be<br />
used for periods<br />
longer than 4 weeks.<br />
O’Keefe, S.J.D.Na.Rev.Gastroenterol.Hepatol,6,210 (2009)<br />
<strong>The</strong> Joint Commission<br />
Sentinel Event Alert: Issue 36 – April 3, 2006<br />
“Tubing misconnections – a persistent <strong>and</strong> potentially deadly occurrence”<br />
Reported cases to Joint Commission:<br />
eight deaths <strong>and</strong> one instance <strong>of</strong> permanent<br />
loss <strong>of</strong> function; 7 adults <strong>and</strong> 2 infants<br />
“tube feeding formula is accidentally connected to intravenous<br />
or other lines or catheters for which it was not intended”<br />
<strong>The</strong> Joint Commission Sentinel Event Alert, Issue 36, April 3, 2006.<br />
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