scholarly journals Gastrostomy tube feeding in adults: the risks, benefits and alternatives

2011 ◽  
Vol 70 (3) ◽  
pp. 293-298 ◽  
Author(s):  
Sue Cullen
Keyword(s):  
Enteral Nutrition ◽  
Poor Prognosis ◽  
Multidisciplinary Approach ◽  
Tube Feeding ◽  
Oral Route ◽  
Gastrostomy Tube ◽  
Vulnerable Group ◽  
Care Needs ◽  
Nasogastric Tubes ◽  
Case Basis

Enteral feeding (or ‘tube feeding’) is a very common inpatient intervention to maintain nutritional status where the oral route is inadequate, unsafe or inaccessible. A proportion of patients will need to continue tube feeding in the community after their admission and will require a gastrostomy tube. Although gastrostomy insertion is relatively straightforward, it is not without complications in an often frail and vulnerable group of patients and a multidisciplinary approach is necessary to ensure that the procedure is appropriate. Some patients are better managed with careful assisted hand feeding or nasogastric tubes. Particular care needs to be taken in deciding whether patients with dementia should have a gastrostomy in view of data suggesting that this group of patients have a particularly poor prognosis after the procedure. Decisions regarding the provision of enteral nutrition at the end of life or where patients are not competent to make an informed judgement are particularly challenging and need to be made on a case-by-case basis.

scholarly journals Nasogastric Tube Feeding in Older Patients: A Review of Current Practice and Challenges Faced

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Devkishan Chauhan ◽  
Surabhi Varma ◽  
Melanie Dani ◽  
Michael B. Fertleman ◽  
Louis J. Koizia
Keyword(s):  
Enteral Nutrition ◽  
Nasogastric Tube ◽  
Older Patients ◽  
Current Practice ◽  
Tube Feeding ◽  
Oral Route ◽  
Tube Placement ◽  
Nasogastric Feeding ◽  
National Patient ◽  
Nasogastric Tube Feeding

Nasogastric tube feeding is an essential way of delivering enteral nutrition when the oral route is insufficient or unsafe. Malnutrition is recognised as a reversible factor for sarcopenia and frailty. It is therefore crucial that malnutrition is treated in older inpatients who have dysphagia and require enteral nutrition. Despite five National Patient Safety Alerts since 2005, “Never Events” related to nasogastric feeding persist. In addition to placement errors, current practice often leads to delays in feeding, which subsequently result in worse patient outcomes. It is crucial that tube placement is confirmed accurately and in a timely way. Medical advancements in this area have been slow to find a solution which meets this need. In this paper, we provide an updated review on the current use of feeding nasogastric tubes in the older population, the issues associated with confirming correct placement, and innovative solutions for improving safety and outcomes in older patients.

EFFECT OF BREAST MILK ADMINISTERED ORALLY AS MINIMAL ENTERAL NUTRITION PRIOR TO TUBE FEEDING (OMEN) IN PRETERM INFANTS – SINGLE CENTER RANDOMIZED CONTROL TRIAL

2021 ◽  
pp. 13-14
Author(s):  
Shilpa U Kalane ◽  
Arti P Rajhans ◽  
Rajan V Joshi ◽  
Uday P Devaskar ◽  
Nandkumar G Kanade
Keyword(s):  
Enteral Nutrition ◽  
Very Low Birth Weight ◽  
Tube Feeding ◽  
Oral Route ◽  
Oral Feeding ◽  
Positive Trend ◽  
Open Label ◽  
Randomized Control ◽  
Full Volume ◽  
Hospital Stay Duration

BACKGROUND: Safety and clinical benets of early Minimum Enteral Nutrition (MEN) have been demonstrated by several trials. MEN is administered as tube feed bypassing the oral phase of digestion. Oropharyngeal administration of colostrum has shown positive trend to achieve feed tolerance. Aims: To study the effect of early initiation and subsequent continuation of minimal oral feeding prior to tube feeds on duration to achieve of full enteral feeds. METHODOLOGY: DESIGN: Open label RCT. Setting: Tertiary level care NICU. Participants: Hundred preterm very low birth weight neonates with no anomaly. Intervention: Infants received 3mL/kg/d of breastmilk or nothing via oral route q2h, beginning within 24-48h of birth which was continued until oral feedings initiated. In both groups tube feeds were introduced (10 ml/kg/d within 24-96 h) & increased (10-20 ml/kg/d) until 180 ml/kg/d. Oral feeding was based on infants cues and a post menstrual age of ≥32 week or weight ≥1250 gram. Outcome: Primary: Time to reach full tube feeds (days). Secondary: NEC, sepsis, mortality, and duration of hospital stay. Duration: 1 year. RESULTS: Infants in OMEN group reached full enteral feeds earlier (14.2 ± 9.0 vs 18.8 ± 11.8, p 0.03) and were discharged at relatively younger post menstrual age compared to those in the TMEN group. There was no signicant difference in the incidence of NEC, sepsis and mortality. CONCLUSION: Administration of small quantity of human milk orally before each tube feed led to earlier achievement of full volume enteral feeds.

scholarly journals Nasojejunal Feeding Is Safe and Effective Alternative to Feeding Jejunostomy for Postoperative Enteral Nutrition in Gastric Cancer Patients

2020 ◽  
Vol 9 (02) ◽  
pp. 070-073
Author(s):  
Kalita Deepjyoti ◽  
Srinivas Bannoth ◽  
Joydeep Purkayastha ◽  
Bibhuti B. Borthakur ◽  
Abhijit Talukdar ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Enteral Nutrition ◽  
Tube Feeding ◽  
Definitive Treatment ◽  
Feeding Jejunostomy ◽  
Causes Of Mortality ◽  
Nasojejunal Feeding ◽  
Gastric Cancer Patients ◽  
Bile Leaks ◽  
Technical Safety

Abstract Background and Aim Carcinoma of the stomach is one of the leading causes of mortality worldwide. Surgery for gastric cancer in the form of total or distal gastrectomy is definitive treatment. Feeding jejunostomy (FJ) though improves postoperative nutritional status and outcome, it is not devoid of its complications. In this study, we present the outcomes of nasojejunal (NJ) feeding and FJ and complications associated with them. Materials and Methods It is both retrospective and prospective observational study in patients with gastric cancer undergoing surgery. Patients were divided into two groups: those who underwent FJ and those who underwent NJ route of feeding placed intraoperatively. Results A total of 279 patients of gastric cancer who underwent surgery were taken into study, of which, 165 were male and 114 females. FJ was done in 42 and NJ in 237 patients, respectively. Gastrectomy + NJ was done in 128 patients, gastrectomy + FJ in 27 patients, gastrojejunostomy + NJ in 109 patients, and FJ in 15 patients. We had three patients of bile leaks in FJ group, of which one patient had intraperitoneal leak who needed re-exploration; rest of the two had peri-FJ external leaks, who were managed conservatively. Most of the complications of NJ group were minor. Conclusion Our study of 279 patients in gastric cancer has shown that FJ is sometimes associated with major complications with increased hospital stay and morbidity when compared with NJ tube feeding without any difference in nutritional outcomes. Hence, NJ route of postoperative enteral nutrition can be considered as an alternative to FJ wherever feasible in view of its technical safety and minor complications and morbidity.

scholarly journals Therapeutic Efficacy of Nasoenteric Tube Feeding in Children Needing Enteral Nutrition

2021 ◽  
Vol 9 ◽  
Author(s):  
Mi-Chi Chen ◽  
Hsun-Chin Chao ◽  
Pai-Jui Yeh ◽  
Ming-Wei Lai ◽  
Chien-Chang Chen
Keyword(s):  
Enteral Nutrition ◽  
Pediatric Patients ◽  
Growth Parameters ◽  
Bowel Perforation ◽  
Tube Feeding ◽  
Oral Feeding ◽  
Tube Placement ◽  
Clinical Aspects ◽  
Limited Information ◽  
Therapeutic Benefits

Background: There is limited information on therapeutic benefits and tube-related complications of pediatric nasoenteric (NE) tube feeding. We viewed, from different clinical aspects, NE tube feeding in children who are under intolerable conditions.Methods: A 10-years retrospective study enrolled 77 pediatric patients who underwent an endoscopic-guided placement of the NE tube for enteral nutrition. The evaluated data, including growth parameters, feeding volume, parenteral nutrition (PN) dependence, and nutritional markers [serum hemoglobin (Hb) and albumin] before and after NE tube feeding were compared. Tube-related complications and major adverse events were also recorded.Results: A total of 77 patients (including 50 males) underwent 176 endoscopic-guided placements of the NE tube with an average duration of 133.7 (6.0–1,847.3) days. The gastroesophageal reflux disease-related symptoms (vomiting, desaturations, and aspiration pneumonia) improved in 71.4% of patients. Feeding volume increased significantly after intervention, especially in patients with delayed gastric emptying, from 144.8 ± 28.5 to 1,103.1 ± 524.7 ml/days (p < 0.001). Weaning from PN was successfully achieved in 84.3% of patients with an average of 9.33 ± 7.30 days. About 16 patients (20.8%) were subsequently highly compatible with oral feeding after NE tube placement for an average of 24.7 ± 14.1 days. Patients either without neurologic dysfunction or with no ventilator-dependent status had a higher chance of shifting to oral feeding. Weight-for-age z-scores increased by 0.15 ± 1.33 after NE tube intervention. One NE tube-related adverse event, which caused bowel perforation at 6 days post-insertion, was recorded. No direct tube-related mortality was observed.Conclusions: Endoscopic-guided NE tube placement is a relatively safe, non-invasive procedure for pediatric patients who require enteral nutrition. Feeding via NE tube showed beneficial effects such as improvement in symptoms, PN weaning, and maintenance of body growth without major tube-related complications.

scholarly journals An Overview of Psychogenic Non-Epileptic Seizures: Etiology, Diagnosis and Management

2018 ◽  
Vol 45 (2) ◽  
pp. 130-136 ◽  
Author(s):  
Ángela Milán-Tomás ◽  
Michelle Persyko ◽  
Martin del Campo ◽  
Colin M. Shapiro ◽  
Karl Farcnik
Keyword(s):  
Poor Prognosis ◽  
Multidisciplinary Approach ◽  
Treatment Algorithm ◽  
Family Physicians ◽  
Epileptic Seizures ◽  
National Registry ◽  
Diagnosis And Management ◽  
Ovid Medline ◽  
The Family ◽  
Embase Database

AbstractThe purpose of this review is to provide an update of the research regarding the etiology, diagnosis and management of psychogenic non-epileptic seizures (PNES). A literature search using Pubmed, Ovid MEDLINE and EMBASE database was performed from 2000 up to August 2017. We have evaluated the different factors leading to PNES as well as the diagnostic approach and management of this disorder which continue to be very difficult. The coexistence of epilepsy and PNES poses special challenges and requires the coordinated efforts of the family physicians, psychiatrists, psychologists and neurologists. Although this condition has an overall poor prognosis, a multidisciplinary approach in the diagnosis and management of this disorder would likely improve the outcomes. We have proposed a diagnostic and treatment algorithm for PNES and suggested a national registry of patients suffering from this condition. The registry would contain data regarding treatment and outcomes to aid in the understanding of this entity.

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