Blogs to Boards: Question 12b

The family is concerned that Mrs. A’s aspirations will continue if she continues to be fed by hand in the nursing home.   They would like to know about more about the risks of a feeding tube placement.

The most appropriate risk to include in the discussion is:

  1. She will have a 1 in 10 chance of a major surgical complication in the perioperative period.
  2. She is unlikely to have a tube related complication after the perioperative period
  3. Once the tube is placed, it would be technically difficult to electively remove the tube
  4. She will have a 1 in 3 chance of requiring chemical or physical restraints to prevent tube removal

Discussion: Correct answer is (d)

  1. Up to one-third experience transient gastrointestinal adverse effects (ie, vomiting, diarrhea) but major complications like bowel perforations are rare (1%)
  2. Tube dislodgement, blockage, and leakage are common (4%-11%).  One in 5 tube-fed residents experiencing a tube related complication necessitating a hospital transfer in the year following insertion.
  3. Removal of feeding tubes is not technically difficult.  An important pearl to know is that if a feeding tube is inadvertently removed, the stoma site will close in a few hours, so put in a Foley catheter to keep it open until a new one can be placed.
  4. Over a quarter of tube fed dementia patients are physically restrained after feeding tube placement, and nearly a third are placed on sedating medications to prevent them from pulling out the feeding tube.