Technical Complications

Technical or mechanical complications are encountered frequently in the EN patient. Tube occlusion most commonly is related to formula occlusion or medication administration through the tube. An important practice to help prevent medication-related occlusion is adequate water flushing of the tube before, between, and after each medication is given through the tube. If intermittent feedings are used, water flushing after each feeding is recommended. Tube occlusion can increase cost of EN significantly if the tube has to be removed and replaced. Clearing of the occlusion using water or pancreatic enzymes plus sodium bicarbonate can be attempted, and special devices

and kits (e.g., DeClogger) are available for this purpose.

Tube displacement is a potentially significant complication of EN. This may be seen secondary to an agitated patient pulling at the tube, or in some cases the tip of the tube migrates spontaneously. The danger of this complication arises if the tip of the tube is positioned in the tracheobronchial tree and feeding is delivered to this area, potentially leading to pneumonia, pneumothorax, and other problems. Location of the tip of the feeding tube should be confirmed initially by chest radiograph after placement and before use. For ongoing assessment of tube placement, auscultation and measurement of aspirate pH can be used; debate continues as to the best method of monitoring tube placement.

Endoscopic and surgical feeding tubes can be complicated by erosion of the exit site caused by leakage of gastric or intestinal contents onto the skin. This complication must be addressed by good wound care and repair or replacement of the access device. Similarly, NG, ND, and NJ tubes can be complicated by nasopharyngeal irritation or necrosis. This is one reason why such tubes should be considered for short-term use only.

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