Common Complications of Tube Feeding

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

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)

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

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

Tube migration from stomach to small intestine

• Pull on tube to reposition against stomach wall

Cold feedings

• Warm feedings to room temperature

Rapid GI transit

• Select fiber enriched formula

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

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

Excessive flavorings

• Stop using flavorings

• Decrease fat in formula or use MCT Oil
• Refer to physician

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

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

Large residuals

Decreased gastric motility

• Elevate child's head during feeding
• Use gastric stimulant to promote gastric emptying
• Consider continuous feeds

Hyperosmolar formula

• Switch to breast milk or isotonic formula

Medications

• Do not add medications to formula; give between feeding with water or juice
• Refer to physician

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

Hyponatremia

• Refer to physician
• Replace sodium losses
• Restrict fluids

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

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

Bleeding around stoma

• 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

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

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