Complications related to feeding tube placement

Purpose of reviewBlind placement of a feeding tube can result in serious complications. Given the widespread use of tube feedings, even a small percentage of such problems can affect a significant number of people. The purpose of this review is to describe recent reports of feeding tube placement problems and to examine possible solutions. Recent findingsMultiple case reports of complications of malpositioned feeding tubes continue to surface; most are due to inadvertent placement in the respiratory tract. A tube with feeding ports in the esophagus significantly increases risk for aspiration, as does the displacement of a small bowel tube into the stomach of a patient with significantly slowed gastric motility. Isolated reports of a nasally placed tube entering the brain following head injury continue to occur, as do reports of esophageal and gastric perforation in neonates. A recent study showed that malpositioned tubes are not routinely recorded in risk management databases; it further demonstrated that a comprehensive intervention to reduce complications from small-bore nasogastric feeding tubes was effective. SummaryComplications related to malpositioned feeding tubes are usually preventable. Poor reporting of feeding tube placement errors hinders the adoption of effective protocols to prevent such errors.

[1]  Cheri S. Blevins,et al.  Detection of inadvertent airway intubation during gastric tube insertion: Capnography versus a colorimetric carbon dioxide detector. , 2006, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[2]  A. Day,et al.  Nutrition support in the critical care setting: current practice in canadian ICUs--opportunities for improvement? , 2003, JPEN. Journal of parenteral and enteral nutrition.

[3]  N. Metheny Preventing respiratory complications of tube feedings: evidence-based practice. , 2006, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[4]  T. Dahms,et al.  Efficacy of dye-stained enteral formula in detecting pulmonary aspiration. , 2002, Chest.

[5]  N. Metheny,et al.  Indicators of postpyloric feeding tube placement in children , 2000, Critical care medicine.

[6]  A. Halbower,et al.  Food dye use in enteral feedings: a review and a call for a moratorium. , 2002, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[7]  S. L. Donaldson,et al.  The WHO World Alliance for Patient Safety : towards the years of living less dangerously , 2004 .

[8]  P. Séguin,et al.  Évaluation prospective de trois méthodes de positionnement de la sonde nasogastrique en réanimation , 2005 .

[9]  N. Metheny Inadvertent intracranial nasogastric tube placement. , 2002, The American journal of nursing.

[10]  T. Dahms,et al.  Detection of pepsin in tracheal secretions after forced small-volume aspirations of gastric juice. , 2004, JPEN. Journal of parenteral and enteral nutrition.

[11]  S. Premji Enteral Feeding for High‐risk Neonates: A Digest for Nurses Into Putative Risk and Benefits to Ensure Safe and Comfortable Care , 2005, The Journal of perinatal & neonatal nursing.

[12]  M. Bennett,et al.  Evaluation of a technique for blind placement of post-pyloric feeding tubes in intensive care: application in patients with gastric ileus , 2006, Intensive Care Medicine.

[13]  R. Vasconcellos,et al.  Inadvertent intracranial placement of a nasogastric tube in a patient with severe craniofacial trauma: a case report. , 2004, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[14]  S. McClave,et al.  Pre-pyloric versus post-pyloric feeding. , 2005, Clinical nutrition.

[15]  L. Filippi,et al.  Use of polyvinyl feeding tubes and iatrogenic pharyngo‐oesophageal perforation in very‐low‐birthweight infants , 2005 .

[16]  F. Martínez,et al.  Traumatic complications from placement of thoracic catheters and tubes , 2005, Emergency Radiology.

[17]  M. Ellett Important facts about intestinal feeding tube placement. , 2006, Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates.

[18]  N. Metheny,et al.  Indicators of tubesite during feedings. , 2005, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[19]  David A Spain,et al.  North American Summit on Aspiration in the Critically Ill Patient: consensus statement. , 2002, JPEN. Journal of parenteral and enteral nutrition.

[20]  Y. Ouchi,et al.  Nasogastric tube feeding is a cause of aspiration pneumonia in ventilated patients , 2006, European Respiratory Journal.

[21]  W. Pickett,et al.  Colorimetric carbon dioxide detector to determine accidental tracheal feeding tube placement , 2005, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[22]  K. Daphtary,et al.  Gastric vs small-bowel feeding in critically ill children receiving mechanical ventilation: a randomized controlled trial. , 2004, Chest.

[23]  J. Stechmiller,et al.  Standards for specialized nutrition support for adult residents of long-term care facilities. , 2006, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[24]  S. Rubertsson,et al.  Malpositioning of fine bore feeding tube: A serious complication , 2005, Acta anaesthesiologica Scandinavica.

[25]  J. Gottlieb,et al.  Enhancing patient safety during feeding-tube insertion: a review of more than 2,000 insertions. , 2006, JPEN. Journal of parenteral and enteral nutrition.

[26]  Mark D Weber,et al.  A randomized controlled trial comparing three different techniques of nasojejunal feeding tube placement in critically ill children. , 2005, JPEN. Journal of parenteral and enteral nutrition.

[27]  W. Baskin Acute complications associated with bedside placement of feeding tubes. , 2006, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[28]  V. Rahimi-Movaghar,et al.  Intracranial placement of a nasogastric tube a lesson to be re-learnt? , 2005, Acta Neurochirurgica.

[29]  B. Ure,et al.  Laparoscopic repair of neonatal gastric perforation. , 2006, Journal of pediatric surgery.

[30]  K. Polderman,et al.  Hospital-acquired sinusitis is a common cause of fever of unknown origin in orotracheally intubated critically ill patients , 2005, Critical care.

[31]  T. Dahms,et al.  Verification of inefficacy of the glucose method in detecting aspiration associated with tube feedings. , 2005, Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses.

[32]  M. Uchino,et al.  Intermittent oro‐esophageal tube feeding in acute stroke patients – a pilot study , 2006, Acta neurologica Scandinavica.

[33]  R. Gedeborg Minimizing trauma of feeding tube exchange in patients with bleeding diathesis , 2005, Paediatric anaesthesia.

[34]  S. Brister,et al.  Thoracic complications of nasogastric tube: review of safe practice. , 2005, Interactive cardiovascular and thoracic surgery.

[35]  M. Hall-Lord,et al.  Enteral nutrition in intensive care nurses' perceptions and bedside observations. , 2006, Intensive & critical care nursing.

[36]  A. Halbower,et al.  Systemic absorption of food dye in patients with sepsis. , 2000, The New England journal of medicine.

[37]  American association of critical-care nurses. , 1975, Heart & lung : the journal of critical care.

[38]  D. Spain,et al.  Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients* , 2005, Critical care medicine.

[39]  L. García-Consuegra,et al.  Intracranial placement of a nasogastric tube after severe craniofacial trauma. , 2000, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[40]  M. Kollef,et al.  Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: Frequency, outcomes, and risk factors , 2006, Critical care medicine.

[41]  A. Marshall,et al.  Enteral feeding in the critically ill: are nursing practices contributing to hypocaloric feeding? , 2006, Intensive & critical care nursing.

[42]  C. Goodman American Society for Parenteral and Enteral Nutrition , 1988 .

[43]  B. Laviolle,et al.  [Testing nasogastric tube placement: evaluation of three different methods in intensive care unit]. , 2005, Annales francaises d'anesthesie et de reanimation.