Table: Possible Problems With Tube Feeding-Merck Manual Consumer Version

Possible Problems With Tube Feeding

Problem	Possible Effects	Comments
Tube-related
Presence of the tube in the nose or mouth	Discomfort Damage to the nose, throat, or esophagus Sinusitis	A tube in the nose or mouth, particularly if large, can irritate tissues, causing pain and sometimes bleeding. In such cases, the tube is usually removed, and feedings are continued with a different kind of feeding tube. Sinuses can become blocked, making infections (sinusitis) more likely.
Incorrect placement of the tube inserted through the nose or mouth	Damage to the affected area Coughing and gagging Pneumonia	Rarely, a tube in the nose or mouth goes down the airways rather than the esophagus. As a result, food can enter the lungs. When the tube is placed in the airways, people who are conscious and alert cough and gag.
Incorrect replacement of a tube previously placed directly into the stomach or intestine	Peritonitis	When a tube shifts out of place, it must be removed and placed again. If the tube was originally inserted directly into the stomach or intestine, reinserting the tube is more difficult, and the tube may be placed outside the digestive tract. Then food can enter the space around the abdominal organs (abdominal cavity). As a result, the membrane that lines that space may become infected—a serious infection called peritonitis.
Blockage of a tube	Inadequate nutrition	Thick formulas or pills can block a tube. Sometimes doctors can dissolve the blockage by adding certain enzymes or substances formulated to break foods down.
Accidental expulsion of a tube	Inadequate nutrition	Tubes often come out accidentally. If a tube is still needed to provide nutrition, it must be replaced.
Formula-related
Intolerance of the formula	Diarrhea, digestive upset, nausea, and vomiting	The formula causes intolerable digestive symptoms in up to 20% of people being fed through a tube and in 50% of those with a serious illness. These symptoms are more common when feedings are given in large amounts (called boluses) given several times a day rather than continuously over longer periods of time.
Diarrhea	Frequent, loose stools
Imbalances in nutrients	Abnormal levels of electrolytes Abnormally high levels of blood sugar (hyperglycemia) Too much fluid in the body (volume overload)	Doctors regularly measure weight (to check for too much water) and blood levels of electrolytes, sugar, and other substances. They then adjust the formula as needed.
Other
Backward flow of the stomach's contents into the esophagus (reflux) Excess secretions in the mouth and throat	Inhalation (aspiration) of the formula into the lungs, which causes coughing and choking and increases the risk of infection such as pneumonia	If people have either of these problems, they may inhale the formula into the lungs even though the tube is placed correctly and the head of the bed is elevated.

Problem

Possible Effects

Comments

Tube-related

Presence of the tube in the nose or mouth

Discomfort

Damage to the nose, throat, or esophagus

Sinusitis

A tube in the nose or mouth, particularly if large, can irritate tissues, causing pain and sometimes bleeding. In such cases, the tube is usually removed, and feedings are continued with a different kind of feeding tube.

Sinuses can become blocked, making infections (sinusitis) more likely.

Incorrect placement of the tube inserted through the nose or mouth

Damage to the affected area

Coughing and gagging

Pneumonia

Rarely, a tube in the nose or mouth goes down the airways rather than the esophagus. As a result, food can enter the lungs. When the tube is placed in the airways, people who are conscious and alert cough and gag.

Incorrect replacement of a tube previously placed directly into the stomach or intestine

Peritonitis

When a tube shifts out of place, it must be removed and placed again. If the tube was originally inserted directly into the stomach or intestine, reinserting the tube is more difficult, and the tube may be placed outside the digestive tract. Then food can enter the space around the abdominal organs (abdominal cavity). As a result, the membrane that lines that space may become infected—a serious infection called peritonitis.

Blockage of a tube

Inadequate nutrition

Thick formulas or pills can block a tube. Sometimes doctors can dissolve the blockage by adding certain enzymes or substances formulated to break foods down.

Accidental expulsion of a tube

Inadequate nutrition

Tubes often come out accidentally. If a tube is still needed to provide nutrition, it must be replaced.

Formula-related

Intolerance of the formula

Diarrhea, digestive upset, nausea, and vomiting

The formula causes intolerable digestive symptoms in up to 20% of people being fed through a tube and in 50% of those with a serious illness. These symptoms are more common when feedings are given in large amounts (called boluses) given several times a day rather than continuously over longer periods of time.

Diarrhea

Frequent, loose stools

Imbalances in nutrients

Abnormal levels of electrolytes

Abnormally high levels of blood sugar (hyperglycemia)

Too much fluid in the body (volume overload)

Doctors regularly measure weight (to check for too much water) and blood levels of electrolytes, sugar, and other substances. They then adjust the formula as needed.

Other

Backward flow of the stomach's contents into the esophagus (reflux)

Excess secretions in the mouth and throat

Inhalation (aspiration) of the formula into the lungs, which causes coughing and choking and increases the risk of infection such as pneumonia

If people have either of these problems, they may inhale the formula into the lungs even though the tube is placed correctly and the head of the bed is elevated.