Complication |
Possible Cause(s) |
Intervention |
Nausea/Vomiting and Diarrhea |
Rapid administration of feeding |
- For continuous drip feeding, return infusion rate to previous tolerated level. Then gradually increase rate
- For bolus feeding, increase length of time for feeding. Allow for short break during feeding. Offer smaller and more frequent feedings
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Hyperosmolar solution
(high calorie and/or high protein formulas) |
- Switch to isotonic formula
- Dilute current formula to isotonic strength and gradually increase to full strength
- Check that formula is mixed properly
- Avoid adding other foods to formula (i.e., baby food, powdered formula)
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Medication |
- Do not add medication to formula; give between feeding with water or juice (for infants over 6 months CA)
- Meds that may cause diarrhea include: antibiotics, GI neurologic stimulants beta blockers, laxatives, stool softeners, liquid meds with sorbitol ie. theophyline
- Review medication profile and change if possible
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Air in stomach/intestine |
- Burp child during feedings or allow for short breaks
- Use medication to decrease gas, ie.simethicone
- Elevate child's head during feeding and for 30 minutes after meal
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Tube migration from stomach to small intestine |
- Pull on tube to reposition against stomach wall
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Cold feedings |
- Warm feedings to room temperature
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Rapid GI transit |
- Select fiber enriched formula
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Bacterial contamination |
- Use breast milk that has been safely collected and stored
- Refrigerate open cans of formula and keep only as long as manufacturer suggests
- Clean tops of formula cans before opening
- Hang only 4 hour amount of formula at a time
- Be sure feeding sets are cleaned well
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Allergy/lactose intolerance |
- Switch to breast milk or lactose-free formula
- Try soy formula. If allergic to soy, may need elemental or semi-elemental formula
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Excessive flavorings |
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- Decrease fat in formula or use MCT Oil
- Refer to physician
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Constipation |
Inadequate fiber/bulk or fluid |
- Try formula with added fiber
- Increase water
- Try supplementing with prune juice
- Try stool softeners, suppositories, or enema, as indicated
- Refer to physician
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Gastroesophageal reflux |
Delayed gastric emptying |
- Refer to physician
- May recommend medication to stimulate GI tract
- Elevate child's head (30-45 degree angle) during feeding and for 1 hour after meal
- Check for residuals before feeding
- Try smaller, more frequent bolus feedings or continuous drip feeding
- Consider Jejunal feeding
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Large residuals |
Decreased gastric motility |
- Elevate child's head during feeding
- Use gastric stimulant to promote gastric emptying
- Consider continuous feeds
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Hyperosmolar formula |
- Switch to breast milk or isotonic formula
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Medications |
- Do not add medications to formula; give between feeding with water or juice
- Refer to physician
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Tube feeding syndrome (dehydration, azotemia, and hypernatremia) |
Excessive protein intake with inadequate fluid intake |
- Refer to physician
- Decrease protein
- Increase fluids. Monitor fluid intake and output
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Hyponatremia |
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- Refer to physician
- Replace sodium losses
- Restrict fluids
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Clogged feeding tube |
Residue or coagulated protein
Inadequate flushing of tube
Medication |
- Use correct formula
- Flush tubes with water after giving formula or medication
- Flush every 3-4 hours with continuous drip feeds
- Do not mix formula with medication
- Irrigate with air, using syringe
- Gently milk tubing
- Dissolve 1/4 tsp. meat tenderizer in 10 cc water and flush to dissolve clot
- Replace tube
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Leakage of gastric contents |
Improper positioning of child
Tube migration
Increased sized of stoma |
- Place child upright for feeding
- Make sure gastrostomy tube is firmly in place
- Stabilize tube with gauze pads, adjust crosspiece
- If stoma is too large for tube, insert new tube
- Keep skin around stoma clean and dry; use protective ointments and gauze
- If leaking out of button gastrostomy, may need to replace device
- Refer to physician
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Bleeding around stoma |
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- A small amount of bleeding is normal
- Tape tube securely in place to avoid irritation from movement
- Secure tube under child's clothing
- Refer to physician
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Infection of stoma |
Gastric leakage around tube
Stoma site not kept clean
Allergic reaction to soap |
- Correct cause of leakage
- Carefully cleanse and protect stoma
- If stoma site is irritated use plain water or change type of soap used
- Refer to physician for culture and medication
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Granulation tissue |
Body rejecting foreign body
Poorly fitting tube causing friction
Use of antiseizure medication such as Dilantin |
- Keep area clean and dry
- Adjust snugness of PEG tube with crosspiece
- Stabilize tube using tape, bandnet, ace bandage, tube top
- Prevent child from pulling on tube
- Apply silver nitrate as directed by physician
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