Tube-related

Presence of tube

Damage to the nose, pharynx, or esophagus

Sinusitis

The tube, particularly if large, can irritate tissues, causing them to erode.

Sinus ostia can become blocked.

Blockage of tube lumen

Inadequate feeding

Thick feedings or pills can block the lumen, particularly of small tubes. Sometimes blockages can be dissolved by instilling a solution of pancreatic enzymes or other commercial products.

Misplacement of a nasogastric tube intracranially

Brain trauma, infection

A tube may be misplaced intracranially if the cribriform plate is disrupted by severe facial trauma.

Misplacement of a nasogastric or orogastric tube in the tracheobronchial tree

Pneumonia

Responsive patients immediately cough and gag. Obtunded patients have few immediate symptoms.

If misplacement is not recognized, feedings enter the lungs, causing pneumonia.

Dislodgement of a gastrostomy or jejunostomy tube

Peritonitis

After being dislodged, a tube may be replaced into the peritoneal cavity. If tubes were originally placed using invasive techniques, replacement is more difficult and more likely to cause complications.

Formula-related

Intolerance of one of the formula’s main nutrient components

Diarrhea, gastrointestinal discomfort,* nausea, vomiting, mesenteric ischemia (occasionally)

Intolerance occurs in up to 20% of patients and 50% of critically ill patients and is more common with bolus feedings.

Osmotic diarrhea

Frequent, loose stools

Nutrient imbalances

Electrolyte disturbances, hyperglycemia, volume overload, hyperosmolarity

Body weight and blood levels of electrolytes, glucose, magnesium, and phosphate should be frequently monitored (daily during the first week).

Other

Reflux of tube feedings or difficulty with oropharyngeal secretions

Aspiration

Aspiration may occur even though tubes are placed correctly and the head of the bed is elevated if patients have either of these problems.