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feeding tube

Also see medications via enteral tube Indications: - nutritionally support patients unable to eat, but with intact gastrointestinal tract - gastrostomy is indicated for long term enteral nutrition Contraindications: - advanced dementia [7] - assisted oral feeding oral feeding may be preferable, especially in a nursing home setting [10] - feeding tubes do not prolong survival, reduce incidence of pneumonia, improve function, or reduce incidence or severity of pressure ulcers in patients with advanced dementia [5] - demented patients witj feeding tubes placed havr longer mean length of hospital stay (66 vs 15 days) & re more likely to be admitted to intensive care (43% vs 10%) & to die in the hospital (22% vs 10%). [11] - more demented patients with feeding tubes placed die by 1 year (50% vs 28%) [11] - patients with advanced dementia fed via nasogastric tube - do not have meaningfully improved survival - have a higher risk of pneumonia than patients carefully hand fed [12] Procedure: - tube placement either through the nasapharynx into the stomach or small intestine or directly through the abdominal wall - nasojejunal tube may be indicated when high residual volumes occur with a nasogastric tube or for avoidance of pancreatic secretion after acute pancreatitis Complications: - increased incidence of aspiration pneumonia - reports of pneumothorax with 2 of the 3 FDA-approved enteral access systems [9] - metabolic disturbances (electrolyte imbalance) [6] - diarrhea - cellulitis at gastrostomy site [6] - interference with absorption of Sinemet & phenytoin [6] - increased use of physical restraints - increased emergency department visits (for feeding tube malfunction) Management: - elevate head of bed if supine - see enteral nutrition Notes: - feeding tubes may be too frequently placed in demented patients [3] - feeding tube use declined 2000-2014 - use is higher in black nursing home residents than white nursing home residents [8]

Related

enteral nutrition gastrostomy medications via enteral tube nasogastric tube (NGT) placement (gastric intubation) nasojejunal tube

Specific

gastrostomy/jejunostomy (G/J) tube Salem-sump

General

enteral tube

References

  1. Journal Watch 21(19):152, 2001 Heyland et al Crit Care Med 29:1495, 2001
  2. Journal Watch 22(8):62, 2002 Davis AR et al, Crit Care Med 30:586, 2002
  3. Teno JM et al. Hospital characteristics associated with feeding tube placement in nursing home residents with advanced cognitive impairment. JAMA 2010 Feb 10; 303:544. PMID: 20145231
  4. Lopez RP, Amella EJ, Strumpf NE, et al. The influence of nursing home culture on the use of feeding tubes. Arch Intern Med 2010; 170(1):83-88. PMID: 20065203
  5. Teno JM et al Does feeding tube insertion and its timing improve survival? J Am Geriatr Soc. 2012 Oct;60(10):1918-21. PMID: 23002947
  6. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  7. American Geriatrics Society (AGS) Feeding Tubes in Advanced Dementia Position Statement. May 2013 http://www.americangeriatrics.org/files/documents/feeding.tubes.advanced.dementia.pdf - American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee. American Geriatrics Society feeding tubes in advanced dementia position statement. J Am Geriatr Soc 2014 Aug; 62:1590 PMID: 25039796
  8. Mitchell SL, Mor V, Gozalo PL et al. Tube feeding in US nursing home residents with advanced dementia, 2000-2014. JAMA 2016 Aug 16; 316:769. PMID: 27533163 http://jama.jamanetwork.com/article.aspx?articleid=2544627
  9. Brooks M Pneumothorax Events Linked to Placement of Enteral Feeding Tube. Medscape: January 11, 2018 https://www.medscape.com/viewarticle/891200 - FDA MedWatch. Jan 11, 2018 CORRECTION - Feeding Tube Placement Systems: Letter to Health Care Providers - Reports of Pneumothorax Events. Link broken.
  10. Hanson LC Tube Feeding vs Assisted Oral Feeding for Persons With Dementia: Using Evidence to Support Decision-Making. Annals of Long-Term Care, 2013. Jan https://www.hmpgloballearningnetwork.com/site/altc/articles/tube-feeding-versus-assisted-oral-feeding-persons-dementia-using-evidence-support-decision
  11. Hartford AM et al. Use of feeding tubes among hospitalized older adults with dementia. JAMA Netw Open 2025 Feb 20; 8:e2460780 PMID: 39976967 PMCID: PMC11843365 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2830454
  12. Yuen JK, Bernacki R, Chan FHW et al Comparison of Survival and Pneumonia Risk in Advanced Dementia Patients on Nasogastric Tube Feeding versus Careful Hand Feeding. J Gerontol A Biol Sci Med Sci. 2025 Aug 12:glaf165. PMID: 40796169