Complications

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Complications of nasal feeding tubes can be divided into those that occur during the procedure and those that occur post-procedurally (Table 10.2).

2.2.1. Procedural Complications

Procedural complications occur in approximately 10% of nasal tube placements, and include aspiration, epistaxis, or cardiopulmonary compromise related to sedation [19, 37]. Initial misplacement of the nasal tube into the tracheopulmonary tree is the most serious procedural complication, occurring in 2-4% of placements. However, it is clinically unsuspected in 80% of incidences, and as many as half of those cases results in pneumothorax [16, 19, 37-39]. Radiography should be performed prior to tube use to confirm location of those tubes placed without endoscopic or fluoroscopic visualization. Protocols requiring radiographic confirmation have been shown to decrease inadvertent use of malpositioned feeding tubes [16].

2.2.2. Post-Procedural Complications

Post-procedural complications include inadvertent tube dislodgement, malfunction or occlusion of the tube, aspiration of tube feeds, sinusitis, and rarely intestinal ischemia. Dislodgement occurs in up to 41% of cases and often requires removal and replacement [40-42]. Preventative measures include taping or stapling the tube to the nose and/or

Table 10.2

Complications of Nasogastric and Nasoenteric Feeding Tubes

Procedural

Post-procedural

-Aspiration -Epistaxis

-Intrapulmonary placement -Pneumothorax

-Tube dislodgement -Aspiration of feeds -Occlusion of tube -Sinusitis

-Intestinal ischemia cheek and the use of a nasal bridle. Nasal bridle use has been shown to decrease dislodgement, but the risk of nasal septal and tissue trauma and its invasive nature have prevented its widespread acceptance [43] (Fig. 10.1).

Nasal tube occlusion complicates 9-20% of cases and often requires tube replacement [42, 44, 45]. Increasing tube length, decreasing tube caliber, inadequate flushing, frequent medication administration, and the use of the tube to measure residual volumes are all associated with an increased incidence of occlusion [46]. A cytology brush, an ERCP catheter, or a commercial corkscrew device may be used in attempts at clearing occlusion [47]; pancreatic enzyme (Viokase, Axcan, Birmingham, AL) mixed with bicarbonate has been shown more effective than traditional measures at resolving tube occlusion [48]. Tube malfunction, including cracking, breaking, or kinking, occurs in 11-20% of nasal tubes; these issues typically result in removal and replacement of the tube [44, 45]. Average in situ functional tube duration is ~ 10-11 days in most studies [34, 35].

Aspiration of tube feeding occurs more frequently in patients with previous aspiration events, decreased level of consciousness, significant

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