The impact of different medical complications on the feasibility of removing the feeding tube from infants with dysphagia

2021 ◽  
Vol 14 (3) ◽  
pp. 371-377
Author(s):  
Hikari Fukatsu ◽  
Kanji Nohara ◽  
Nobukazu Tanaka ◽  
Nami Fujii ◽  
Takayoshi Sakai
Keyword(s):  
Tube Feeding ◽  
Feeding Tube ◽  
Cardiovascular Complications ◽  
Oral Feeding ◽  
Medical Complications ◽  
Cardiac Complications ◽  
Medical Complication ◽  
Feeding Tubes ◽  
Tube Removal ◽  
The Impact

PURPOSE: This study examined whether certain medical complications influence the feasibility of tube removal. METHODS: 42 subjects with dysphagia who were under the age of 2.5 years were nourished entirely through feeding tubes. Additionally, they were judged to have no aspiration. The following data about the infants were collected through a retroactive survey: age at which oral feeding training commenced, gender, and whether certain medical complications (cardiovascular, respiratory, digestive, neurological, or oral) had been present at birth. The data were analyzed to determine which type of medical complication affected the likelihood of removing the feeding tube from the infant at 3 years of age. RESULTS: Of the five medical complications examined, cardiovascular complications significantly affected the feasibility of tube removal (p = 0.049). CONCLUSION: Pediatric dysphagia patients with cardiac complications, compared to those with other complications, may take longer to transition off tube feeding.

scholarly journals Dysphagia in Perry Syndrome: Pharyngeal Pressure in Two Cases

2017 ◽  
Vol 9 (2) ◽  
pp. 161-167 ◽  
Author(s):  
George Umemoto ◽  
Yoshio Tsuboi ◽  
Hirokazu Furuya ◽  
Takayasu Mishima ◽  
Shinsuke Fujioka ◽  
...  
Keyword(s):  
Tube Feeding ◽  
Oral Intake ◽  
Normal Diet ◽  
Oral Feeding ◽  
Tongue Pressure ◽  
Normal Range ◽  
Swallowing Function ◽  
Pharyngeal Pressure ◽  
Swallowing Dysfunction ◽  
The Impact

Background: To investigate the impact of dysphagia in Perry syndrome (PS), an autosomal dominant parkinsonism caused by mutation of DCTN1, which is associated with hypoventilation, depression, and weight loss. Case Presentation: We used tongue pressure measurements and manofluorography to investigate swallowing function in 2 patients with PS. Case 1, a 60-year-old male showing parkinsonism, and case 2, a 49-year-old male admitted with pneumonia, were diagnosed as having PS based on the DCTN1 gene analysis. Case 1 showed a pharyngeal retention of the bolus on videofluorography (VF) and a few swallows were required for its passage into the esophagus. However, tongue pressure and manometry were within the normal range. This patient could eat a normal diet under supervision. Case 2 required artificial ventilation and tube feeding on admission. The VF image showed a slow transfer of the bolus, delayed swallow reflex, and pharyngeal retention of the bolus that required several swallows for its passage into the esophagus. The tongue pressure was within the normal range, but manometry showed a significant decrease in pressure at the hypopharynx and upper esophageal sphincter. The oral intake of the patients was limited to 2 cups of jelly per day. Conclusions: The investigation of swallowing dysfunction of 2 cases of PS showed that maintaining pharyngeal pressure within the normal range was very important for oral feeding success and prognosis.

An Algorithmic Approach to Nutritional Difficulties in People With Developmental Disabilities

2019 ◽  
Vol 57 (1) ◽  
pp. 14-25
Author(s):  
Suma Chennubhotla ◽  
Rebecca Hertog ◽  
John E. Williams ◽  
Debra Hanna ◽  
Thomas L. Abell
Keyword(s):  
Developmental Disabilities ◽  
Nutritional Support ◽  
Healthcare Providers ◽  
Tube Feeding ◽  
Later Life ◽  
Oral Feeding ◽  
Medical Complications ◽  
Critical Problem ◽  
Algorithmic Approach ◽  
Gastrointestinal Dysmotility

Abstract With the increasing survival rate of people with developmental disabilities into adulthood and later life, nutritional support and feeding of these individuals frequently becomes a critical problem which must be addressed by their caregivers and healthcare providers. Problems surrounding mealtimes include difficulty with the mechanisms of feeding as well as medical complications including aspiration and gastrointestinal dysmotility. No comprehensive guidelines exist to aid caregivers and healthcare providers regarding the issues in feeding and nutrition in this population. We offer an algorithmic approach to the nutrition-related problems of aspiration, laborious meals and mealtime refusal, choosing the best route for tube feeding, and when to return patients with developmental disabilities back to oral feeding.

scholarly journals Managing Eating Disorders in Elderly with Dementia and the Ethical Considerations for Tube Feeding

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Quality Of Life ◽  
Eating Disorders ◽  
Management Strategies ◽  
Tube Feeding ◽  
The Elderly ◽  
Feeding Tube ◽  
Medical Complications ◽  
Ethical Considerations ◽  
Nutritional Needs

As dementia progresses, the elderly with dementia often have difficulties finishing their meals and weight loss is a common feature at this stage of their dementia journey. Eating disorders cause tremendous caregiver stress and burden. In considering provision of best care for this group of elderly, the hospital is probably not the best place and yet, they are frequently brought in to the hospital to seek help for fever, pneumonia, dislodged feeding tube, medical complications arising from poor feeding and dehydration. It is important to understand the aetiology of poor feeding among this group of patients and advise the patients and their family on the appropriate management strategies to improve the intake of food and to maximize their quality of life. At this stage of dementia, focusing on means to ensure nutritional needs are met may end up causing further harm and distress.

26 Clogged Feeding Tubes: Why Does It Matter?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S22-S23
Author(s):  
Sarah Zavala ◽  
Ashley Wang ◽  
Cheryl W Zhang ◽  
Jennifer M Larson ◽  
Yuk Ming Liu
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Nutritional Support ◽  
Total Body Surface Area ◽  
Tube Feeding ◽  
Feeding Tube ◽  
Admission Diagnosis ◽  
Burn Patients ◽  
Feeding Tubes ◽  
Burn Unit

Abstract Introduction Many patients treated on a burn unit require tube feeding as their primary caloric source or as supplemental feeding due to their injuries. Burn patients specifically require higher caloric intake due to the hypermetabolic state of burn injuries. Inadequate nutritional support contributes to longer ICU stays and higher mortality. Clogged feeding tubes reduce nutrition provided due to temporary discontinuation of feeding. The objective of this study was to identify risk factors for the incidence of tube clogging. Methods This was a single-center retrospective chart review of all patients admitted to an American Burn Association-verified Burn Unit between August 2017 and October 2019 who received tube feeds during their admission. Data collected included baseline demographics, clinical outcomes, and details about tube feed formulations, number of clogs, and details leading up to the clog. Baseline demographics were compared using descriptive statistics. Nominal data was compared using Chi-square test. Continuous data was analyzed using student’s t-test or Mann-Whitney U test. Results A total of 170 patients were included; admission diagnoses included burn (97), soft tissue infections (29), SJS/TEN (11), and others (33). At least one clogged feeding tube was experienced by 51 patients and some experienced up to seven separate clogs. SJS/TEN patients were less likely to experience a clog (9.2 vs 0%, p = 0.035) and frostbite patients were more likely to experience a clog (0 vs 5.9%, p = 0.026). Burn mechanism did not affect incidence of tube feed clog, but patients with larger total body surface area (TBSA) burned were more likely to have a clog (15.55 vs 25.03%, p = 0.004). It was a median of 12 days until the first clog occurred (IQR 7.8–17.3). Two tube feed formulas demonstrated an increased likelihood of clog: a renal formulation (16.8 vs 33.3%, p = 0.017) and a polymeric concentrated product (5.0 vs 17.6%, p = 0.008). Both products have a high viscosity. Patients who experienced a clog had a longer length of stay (21.5 vs 44.0 days, p = 0.001). Conclusions This study identified several risk factors associated with higher incidence of clogged feeding tube in the burn unit including tube feed formulation and viscosity, admission diagnosis, and larger TBSA in burn patients. This study also confirms that clogged feeding tubes, and the resultant insufficient nutritional support, may contribute to an increased length of stay.

Liver Transplantation in Patients With Cardiac Disease

2017 ◽  
Vol 22 (2) ◽  
pp. 111-121 ◽  
Author(s):  
Christopher L. Wray
Keyword(s):  
Cardiovascular Disease ◽  
Liver Transplantation ◽  
Perioperative Period ◽  
Cardiovascular Complications ◽  
Adverse Outcomes ◽  
Treatment Modalities ◽  
Cardiac Complications ◽  
Major Step ◽  
Cardiac Evaluation ◽  
The Impact

Liver transplantation (LT) is a unique surgical procedure that has major hemodynamic and cardiovascular implications. Recently, there has been significant interest focused on cardiovascular issues that affect LT patients in all phases of the perioperative period. The preoperative cardiac evaluation is a major step in the selection of LT candidates. LT candidates are aging in concordance with the general population; cardiovascular disease and their risk factors are highly associated with older age. Underlying cardiovascular disease has the potential to affect outcomes in LT patients and has a major impact on candidate selection. The prolonged hemodynamic and metabolic instability during LT may contribute to adverse outcomes, especially in patients with underlying cardiovascular disease. Cardiovascular events are not unusual during LT; transplant anesthesiologists must be prepared for these events. Advanced cardiovascular monitoring techniques and treatment modalities are now routinely used during LT. Postoperative cardiovascular complications are common in both the early and late posttransplant periods. The impact of cardiac complications on posttransplant mortality is well recognized. Emerging knowledge regarding cardiovascular disease in LT patients and its impact on posttransplant outcomes will have an important role in guiding the future perioperative management of LT patients.

scholarly journals Characterization of Fungal Colonization of Indwelling Esophagostomy Tubes

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Shelly J. Olin ◽  
David A. Bemis ◽  
John R. Dunlap ◽  
Jacqueline C. Whittemore
Keyword(s):  
Structural Integrity ◽  
Case Series ◽  
Morphological Characteristics ◽  
Surface Characteristics ◽  
Feeding Tube ◽  
Fungal Colonization ◽  
Feeding Tubes ◽  
Normal Microbiota ◽  
Tube Exchange ◽  
The Impact

Fungal colonization of feeding tubes occurs rapidly in people, resulting in decreased structural integrity and complications such as luminal obstruction and tube failure. Esophagostomy tubes (E-tubes) are commonly used in dogs and cats for enteral support, but data are lacking regarding colonizing fungi and the impact of colonization on tube integrity. In this study, esophagostomy tubes were collected in lieu of disposal from dogs and cats undergoing feeding tube exchange. Fungi were isolated with culture and identified using morphological characteristics. Scanning electron microscopy was used to evaluate the surface characteristics of the tubes. Two silicone and one polyurethane E-tube were evaluated. Fungi associated with the normal microbiota, including Candida sp. and Penicillium sp., as well as environmental fungi were identified. This case series represents the first documentation of fungal colonization of silicone and polyurethane E-tubes in dogs and cats. Additionally, this is the first report to document degenerative changes in a silicone E-tube.

scholarly journals P-OGC58 Preoperative Enteral Feeding in Patients with Oesophagogastric Cancer

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Cathy White ◽  
Mayilone Arumugusamy ◽  
William Robb
Keyword(s):  
Weight Loss ◽  
Enteral Feeding ◽  
Patient Flow ◽  
Tube Feeding ◽  
Feeding Tube ◽  
Tube Insertion ◽  
Jejunostomy Tube ◽  
Curative Intent ◽  
Additional Support ◽  
The Impact

Abstract Background Patients with Oesophagogastric (OG) cancer undergoing multimodal treatment have a higher risk for progressive decline in their nutritional status. Our centre has seen increased numbers of patients using jejunostomy and gastrostomy tube feeding as an additional support during neoadjuvant chemotherapy and radiotherapy (nCRT).  This audit aimed to evaluate the processes surrounding and the impact of this intervention. Methods A retrospective review of 2019 medical records.  Patients with OG cancer for treatment with curative intent that underwent an elective feeding tube insertion for preoperative supplementary feeding were included. Results 14 patients were admitted for elective feeding tube insertion in 2019. On admission N = 10 patients (71%) had clinically severe weight loss (defined as ≥ 10% in 6 months, or ≥ 7.5% in 3 months or ≥ 5% in 1 month).  Four (29%) had a dietetic assessment pre admission, with 1 patient (7%) trained on home enteral nutrition pre admission. Conclusions This service is growing rapidly, patient numbers have more than doubled in 3 years. Enteral feeding is effective in preventing clinically significant weight loss in patients undergoing nCRT who progress to surgery. Short LOS: dietetic consult pre admission is essential to improve patient flow, education, preparation. Jejunostomy tube dislodged in 46% patients (n = 6), aim to improve strategies to avoid or best manage this.   For future work: Examine effect on body composition (CT: sarcopenia) and examine patient’s perspectives and quality of life.

scholarly journals The impact of Rumex vesicarius seed water extracts on mice fertility

2021 ◽  
Author(s):  
Ahmad Rashed Alhimaidi ◽  
Aiman Abdullah. Ammari ◽  
Mohammad Khair Okla ◽  
Muath Qasem Algadi ◽  
Ramzi Ahmed Amran ◽  
...  
Keyword(s):  
Antioxidant Properties ◽  
Feeding Tube ◽  
Oral Feeding ◽  
The Other ◽  
Female Group ◽  
Mating Group ◽  
Group I ◽  
Significant Difference ◽  
The Impact ◽  
Seed Extracts

AbstractRumex vesicarius (RV) is an edible wild annual plant, and it is reported that it contains a good source of minerals, protein, and ascorbic acid. Several studies have indicated the anti-liver damage, anticancer, antimicrobial, and antioxidant properties of the RV plant. There are currently no reports regarding the effect of RV on fertility. Therefore, this study focuses on the impact of RV water seed extracts on mice fertility. RV plants were collected, and water seed extracts were prepared; 50 mg/kg body weight (BW) of this was then injected into the mice (male and female) using an oral feeding tube 5 days before mating (group I) or during caging of the females with the males for 1 week to detect their fertility rate. In the different female groups, no significant difference between their BW and their newborn’s BW in the treated and control groups was found. Female fertility, pregnancy, and offspring rates showed some variation within each female group and between the different female groups. In comparing the fertility and offspring rate between the different groups, there was a significant difference (P < 0.05) between groups I and III females and between groups I and IV females, while the other groups showed no significant differences. In contrast, the other groups showed no significant differences. Regarding the impact of the water seed extract on males, the BW was approximately the same in control and treated males.

scholarly journals P-OGC62 Home Enteral Tube Feeding: The Patient’s Perspective. Are we delivering an effective dietetic service?

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Neasa Forde ◽  
Cathy White
Keyword(s):  
Beaumont Hospital ◽  
Neoadjuvant Treatment ◽  
Tube Feeding ◽  
Relevant Information ◽  
Feeding Tube ◽  
Curative Intent ◽  
Feeding Tubes ◽  
Feeding Duration ◽  
Number Of Patients ◽  
Reduce Complication Rate

Abstract Background Long term feeding tubes, managed independently at home have been shown to improve quality of life scores and in general are considered to be well tolerated. Beaumont Hospital has seen an increase in the number of patients referred for home enteral feeding (HEN) prior to neoadjuvant treatment for oesophagogastric (OG) cancer.   We aimed to gain an insight into the supports, experiences and challenges encountered by these patients in an emerging service. Methods A retrospective qualitative study using data from 2019-2020. A questionnaire was adapted from a multicentre Irish study in 2017. Patients with OG cancer for treatment with curative intent, that underwent an elective feeding tube insertion for preoperative supplementary feeding were included. Patients were provided with a questionnaire via post. Data was analysed using Microsoft Excel.  Results Response rate was 82% (14 of 17questionnaires).   Mean age 60.4yrs (SD 11.7).  93% male (N = 13).  In 36% (N = 5) tube feeding duration was &lt; 3months and 3-6months duration in 43% (N = 6).  Conclusions Overall positive feedback was received from patients regarding living with a feeding tube, confirming the important and impactful role of HEN. Priorities for service improvements: improved discharge information and resources may help  reduce use of unreliable resources e.g. develop HEN discharge booklet to keep all relevant information in one accessible location, development of video education resources for consolidation of knowledge.  Aim to provide more structured follow up with clear plans and channels of communication outlined for the patient. Quality improvement work with surgical team to reduce complication rate with feeding tubes. 

A case of a ‘lost’ nasogastric tube

2012 ◽  
Vol 126 (12) ◽  
pp. 1296-1298 ◽  
Author(s):  
V Sankar ◽  
M Shakeel ◽  
S Keh ◽  
K W Ah-See
Keyword(s):  
Nasogastric Tube ◽  
Main Bronchus ◽  
Tube Feeding ◽  
X Ray ◽  
Feeding Tubes ◽  
Nasogastric Tubes ◽  
Tube Removal ◽  
Chest X Ray ◽  
Nasogastric Tube Feeding ◽  
Radiotherapy Treatment

AbstractObjectives:To present the case of a ‘lost’ nasogastric tube and to highlight the importance of imaging and/or chest X-ray after nasogastric tube insertion, especially in unreliable patients.Case report:A 50-year-old man, undergoing radiotherapy treatment for squamous cell carcinoma of the tongue base, was admitted for pain control and nasogastric tube feeding. This patient required multiple nasogastric tubes over a two-week period. The patient repeatedly denied pulling the nasogastric tube out and we were unable to establish the exact mode of nasogastric tube removal. On one such occasion another tube was inserted and a check X-ray showed two feeding tubes; the latest one was lying in the left main bronchus and the old nasogastric tube was observed in the oesophagus, with its upper end jutting above the hypopharynx. It was apparent that the patient had somehow cut the tube and swallowed it.Conclusion:This case not only illustrates the importance of flexible nasendoscopy and/or chest X-ray for checking the position of the nasogastric tube, but also highlights that some patients are not tolerant of nasogastric tubes. The use of nasogastric tubes should be avoided in these patients to prevent any self-inflicted injury.

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