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.

scholarly journals Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

2020 ◽  
Author(s):  
Hsiao-Hui Chou ◽  
Meng-Ting Tsou ◽  
Lee-Ching Hwang
Keyword(s):  
Nasogastric Tube ◽  
Older Patients ◽  
Tube Feeding ◽  
Mortality Rates ◽  
Home Healthcare ◽  
Severe Dementia ◽  
Clinical Prognosis ◽  
Increased Risk ◽  
Significant Difference ◽  
Nasogastric Tube Feeding

Abstract Backgrounds: All individuals with severe dementia should be offered careful hand feeding. However, under certain circumstances, people with severe dementia have a feeding tube placed. In Taiwan, tube feeding rate in demented older home care residents is increasing；however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of older patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF). Methods: This retrospective longitudinal study enrolled 169 participants over 60 years of age in the setting of in-home healthcare between January 1 and December 31, 2017. All subjects with documented severe dementia and complete functional dependence suffered from difficulty in oral intake and required either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates. Results: A total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. Of note, 39 required AHF and 130 NGF. All subjects were bedridden; 129 (76%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (48%) than in the AHF group (26%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia was not significantly higher in older subjects belonging to the NGF group compared to the AHF group. One-year mortality rates in the AHF and NGF groups were 8% and 15%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 2.38; 95% CI, 0.58–9.70). There were no significant differences in hospitalization rate and duration. Conclusions: For older patients with dementia requiring in-home healthcare, NGF is not associated with a significantly lower risk of pneumonia than AHF. Additionally, neither mortality nor hospitalization rates decreased with NGF. On the contrary, a non-significant trend of increased risk of pneumonia was observed in NGF group. Therefore, the benefits of NGF are debatable in older patients with severe dementia requiring in-home healthcare. Continued careful hand feeding could be an alternative to NG feeding in patients with severe dementia. Furthermore, large-scale studies on home healthcare would be required to support these results.

scholarly journals Immediate chest radiograph interpretation by radiographers improves patient safety related to nasogastric feeding tube placement in children

2021 ◽  
Author(s):  
Emily Keyte ◽  
Gillian Roe ◽  
Annmarie Jeanes ◽  
Jeannette K. Kraft
Keyword(s):  
Patient Safety ◽  
Nasogastric Tube ◽  
Improve Patient Safety ◽  
Feeding Tube ◽  
Practice Change ◽  
Tube Placement ◽  
Nasogastric Feeding ◽  
Nasogastric Tubes ◽  
National Patient ◽  
Nasogastric Tube Placement

Abstract Background Despite the publication of a national patient safety alert in 2016, inadvertent feeding through misplaced nasogastric tubes continues to occur, either through failure to review the radiograph, misinterpretation of it, or failure to communicate the results. Objective The objectives were to determine whether training in a new pathway introduced to avoid these “never events” was followed and whether radiographer comments and prompt communication of results could reduce risk and improve patient safety in relation to nasogastric tube placement in children. Materials and methods Following radiographer training in interpretation of nasogastric tube position and use of a commenting proforma and communication pathway, we reviewed all radiographs obtained to check nasogastric tubes performed over a 13-month period in children 0–16 years of age. Then we assessed accuracy of the radiographer comments, adherence to the pathway, and any practice change in children with misplaced nasogastric tubes. Results We reviewed 282 nasogastric tube check radiographs. For 262 radiographs (92.9%) the pathway was followed correctly. Of the total 282 radiographs, 240 (85%) were immediately reported using the standardised commenting proforma, and 235 radiographer comments were affirmed by the radiologist (97% accuracy, confidence interval 0.95–0.99). Of the immediately reported radiographs, 213 (88.8%) nasogastric tubes were considered to be safe for use. Four (1.7%) of the immediately reported nasogastric tubes were misplaced in a bronchus, and the report communicated to the clinical team resulted in removal or re-siting of the tubes. Conclusion Nasogastric tube check radiographs in children can be reported accurately by radiographers trained in their interpretation and the results promptly communicated to clinical staff, improving safety in relation to nasogastric tube placement in children.

scholarly journals Enteral Nutrition and Acute Pancreatitis: A Review

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
B. W. M. Spanier ◽  
M. J. Bruno ◽  
E. M. H. Mathus-Vliegen
Keyword(s):  
Acute Pancreatitis ◽  
Enteral Nutrition ◽  
English Language ◽  
Tube Feeding ◽  
Nutrition Therapy ◽  
Nutrition Support ◽  
Nasogastric Feeding ◽  
Medline Search ◽  
Nasogastric Tube Feeding

Introduction. In patients with acute pancreatitis (AP), nutritional support is required if normal food cannot be tolerated within several days. Enteral nutrition is preferred over parenteral nutrition. We reviewed the literature about enteral nutrition in AP.Methods. A MEDLINE search of the English language literature between 1999–2009.Results. Nasogastric tube feeding appears to be safe and well tolerated in the majority of patients with severe AP, rendering the concept of pancreatic rest less probable. Enteral nutrition has a beneficial influence on the outcome of AP and should probably be initiated as early as possible (within 48 hours). Supplementation of enteral formulas with glutamine or prebiotics and probiotics cannot routinely be recommended.Conclusions. Nutrition therapy in patients with AP emerged from supportive adjunctive therapy to a proactive primary intervention. Large multicentre studies are needed to confirm the safety and effectiveness of nasogastric feeding and to investigate the role of early nutrition support.

scholarly journals Association between teeth loss and nasogastric tube feeding dependency in older adults from Taiwan: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chun-Chieh Wang ◽  
Yu-Yen Chen ◽  
Kuo-Chuan Hung ◽  
Shang-Jung Wu ◽  
Yung-Feng Yen ◽  
...  
Keyword(s):  
Older Adults ◽  
National Health ◽  
Nasogastric Tube ◽  
Tube Feeding ◽  
Nasogastric Feeding ◽  
Number Of Teeth ◽  
Increased Risk ◽  
The Mean ◽  
Nasogastric Tube Feeding

Abstract Background To examine the association between teeth loss and nasogastric tube feeding dependency in older people. Methods The National Health Interview Survey (NHIS) 2005, 2009, and 2013 in Taiwan. Participants were selected by a multistage stratified sampling method and baseline characteristics, including socioeconomic status and health habits, were obtained by well-trained interviewers. The NHIS was linked with the National Health Insurance research database 2000–2016 and the National Deaths Dataset, which contains all the medical information of ambulatory and inpatient care. Cox regression was used to examine the association between the number of teeth lost and nasogastric tube feeding dependency. Results There were 6165 adults older than 65 years old enrolled in the analysis, with 2959 male (48%) and the mean (SD) age was 73.95(6.46) years old. The mean follow-up duration was 6.5(3.3) years. Regarding the teeth loss categories, 1660 (26.93%), 2123 (34.44%), and 2382 (38.64%) of participants were categorized as having no teeth loss, loss of 1–9 teeth, and loss of 10–28 teeth, respectively. During 39,962 person-years of follow-up, new-onset nasogastric feeding dependency was recognized in 220(13.25%), 256(12.06%), and 461(19.35%) participants who were categorized as having no teeth loss, loss of 1–9 teeth, and loss of 10–28 teeth, respectively. Kaplan-Meier curves demonstrated significant findings (Log-rank P < 0.01). After potential confounders were adjusted, compared with those without teeth loss, older adults who had lost 10–28 teeth had significantly increased risks of occurrence nasogastric feeding dependency (AHR, 1.31; 95% CI, 1.05–1.62; p-value = 0.02). Furthermore, a significant dose-response relation between the number of teeth lost and increased risk of nasogastric feeding was found (p for trend< 0.01). Conclusions Older adults who had lost 10–28 teeth had a significantly increased risk of nasogastric tube feeding dependency. Early identification of the oral disease is crucial for the prevention of the occurrence of teeth loss and the following nutrition problems, which would reduce risk of nasogastric tube feeding dependency.

scholarly journals Comparison of nutritional effectiveness and complication rate between early nasojejunal and nasogastric tube feeding in patients with an intracerebral hemorrhage

2020 ◽  
Author(s):  
Cong Ling ◽  
Xiling Hu ◽  
Chuan Chen ◽  
Lun Luo ◽  
Meiqin Cai ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Nasogastric Tube ◽  
Complication Rate ◽  
Tube Feeding ◽  
Pulmonary Aspiration ◽  
Tube Placement ◽  
Gastric Retention ◽  
Feeding Group ◽  
Nasojejunal Tube ◽  
Nasogastric Tube Feeding

Abstract BackgroundThis study aimed to compare nutritional effectiveness and complication rate between early nasojejunal and nasogastric tube feeding in patients with an intracerebral hemorrhage.MethodsEighty patients with an intracerebral hemorrhage were randomly divided into a nasojejunal and a nasogastric tube feeding group. Feeding tubes were placed within 6 hours after admission, and enteral feeding began within 2 hours after tube placement. The nutritional status and complication rate of the 2 groups were compared before and 2 and 4 weeks after beginning feeding.ResultsSerum prealbumin, serum albumin, and hemoglobin levels were significantly higher in the nasojejunal tube feeding group than in the nasogastric tube feeding group at 2 and 4 weeks after beginning feeding (all, p < 0.05). The incidence of gastric retention, pulmonary aspiration, and pneumonia were lower in the early nasojejunal tube feeding group than in the early nasogastric tube feeding group (all, p < 0.05). There was no significant difference in the incidence of diarrhea between the 2 groups.ConclusionCompared with early nasogastric feeding, early nasojejunal feeding provides better nutritional effectiveness and a lower incidence of gastric retention, pulmonary aspiration, and pneumonia in patients with an intracerebral hemorrhage.#These authors contributed equally to this work.

scholarly journals Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

2020 ◽  
Author(s):  
Hsiao-Hui Chou ◽  
Meng-Ting Tsou ◽  
Lee-Ching Hwang
Keyword(s):  
Nasogastric Tube ◽  
Older Patients ◽  
Tube Feeding ◽  
Mortality Rates ◽  
Home Healthcare ◽  
Severe Dementia ◽  
Clinical Prognosis ◽  
Increased Risk ◽  
Significant Difference ◽  
Nasogastric Tube Feeding

Abstract Background: All individuals with severe dementia should be offered careful hand feeding. However, under certain circumstances, people with severe dementia have a feeding tube placed. In Taiwan, tube feeding rate in demented older home care residents is increasing；however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of older patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF). Methods: Data from the in-home healthcare system between January 1 and December 31, 2017 were analyzed to identify 169 participants over 60 years of age in this retrospective longitudinal study. All subjects with severe dementia and complete functional dependence suffered from difficulty in oral intake and required either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates. Results: A total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. 39 required AHF and 130 NGF. All subjects were bedridden; 129 (76%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (48%) than in the AHF group (26%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia was not significantly higher in the NGF group compared with the AHF group. One-year mortality rates in the AHF and NGF groups were 8% and 15%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 2.38; 95% CI, 0.58–9.70). There were no significant differences in hospitalization rate and duration. Conclusions: For older patients with dementia requiring in-home healthcare, NGF is not associated with a significantly lower risk of pneumonia than AHF. Additionally, neither mortality nor hospitalization rates decreased with NGF. On the contrary, a nonsignificant trend of increased risk of pneumonia was observed in NGF group. Therefore, the benefits of NGF are debatable in older patients with severe dementia requiring in-home healthcare. Continued careful hand feeding could be an alternative to NG feeding in patients with severe dementia. Furthermore, large-scale studies on in-home healthcare would be required to support these results.

scholarly journals Sluder's neuralgia- A sequalae of nasogastric tube feeding

2020 ◽  
Author(s):  
Joshna Naidu ◽  
Anand Subash ◽  
Vishal Rao
Keyword(s):  
Nasogastric Tube ◽  
Tube Feeding ◽  
Well Being ◽  
Nasogastric Feeding ◽  
Unilateral Headache ◽  
Nutritional Needs ◽  
Physical Comfort ◽  
A Prospective Study ◽  
Persistent Headache ◽  
Nasogastric Tube Feeding

Management of nutritional needs is of paramount importance in cancer patients and nasogastric feeding is the most common method. Nasal cavity being a richly innervated region, is also a hallway for the exposure of the same to external environment. Any trauma or pressure to these nerve endings result in unilateral headache mimicking Sluder’s neuralgia. Nasogastric tube may irritate the nasal mucosa and exert pressure on the nasal turbinates. We believe that the persistent headache in patients with NG tube is distinctly significant that it interferes with the physical comfort of patient. It also influences the sleep patterns, thereby causing repercussions in the emotional well-being. Head and neck oncologists being the primary clinicians, it is imperative to consider the Sluder’s neuralgia in patients with nasogastric tube feeding. This mandates a prospective study to describe the clinical features and the treatment of ‘NGT neuralgia’.

Evaluation of a Semi-Solidifying Liquid Formula for Nasogastric Tube Feeding After Oral and Maxillofacial Surgery

2020 ◽  
Vol 78 (4) ◽  
pp. 663.e1-663.e7
Author(s):  
Shigeo Ishikawa ◽  
Kenichiro Kitabatake ◽  
Kaoru Edamatsu ◽  
Ayako Sugano ◽  
Kazuyuki Yusa ◽  
...  
Keyword(s):  
Nasogastric Tube ◽  
Maxillofacial Surgery ◽  
Tube Feeding ◽  
Oral And Maxillofacial Surgery ◽  
Nasogastric Tube Feeding

scholarly journals Nasogastric Tube Feeding Practice and Associated Complication in stroke Patients in a Tertiary Care Hospital in Bangladesh

2018 ◽  
Vol 4 (1) ◽  
pp. 23-27 ◽  
Author(s):  
Kazi Mohibur Rahman ◽  
Sharif Uddin Khan ◽  
ATM Hasibul Hasan ◽  
Sirajee Shafiqul Islam ◽  
Rajib Nayan Chowdhury ◽  
...  
Keyword(s):  
Aspiration Pneumonia ◽  
Nasogastric Tube ◽  
Tertiary Care ◽  
Tube Feeding ◽  
Electrolyte Imbalance ◽  
Feeding Practice ◽  
Care Hospital ◽  
Stroke Patients ◽  
Nasal Irritation ◽  
Nasogastric Tube Feeding

Background: Nasogastric tube feeding is an integral part of management of stroke patients with feeding difficulties.Objectives: The purpose of the present study was to evaluate the nasogastric tube feeding practice and its complication on stroke patients.Methodology: One hundred (100) adult patients aged ≥ 18 years with stroke were enrolled in the study. The diagnosis of stroke was established by the clinical presentation, neuroimaging. Patients requiring nasogastric tube feeding was included in the study. They were thoroughly examined for any complications from possible use of nasogastric tube. Their caregivers were also thoroughly interviewed using a standard preformed questionnaire regarding any complications as well. Results: A total number of 100 patients were recruited for this study. In this study population, 63.0% patients had ischaemic stroke; 26.0% had haemorrhagic stroke and 9.0% population had sub-arachnoid haemorrhage. The most common indication for NG feeding was difficulty in swallowing (39.0%) followed by semi consciousness (26.0%), unconsciousness (22.0%), inability to maintain feed (10.0%). About 71.0% of the patients had complications from NG tube feeding such as nasal irritation (53.0%), electrolyte imbalance (43.0%), aspiration pneumonia (40.0%) and diarrhea (38.0%).Conclusion: Nasal irritation, aspiration pneumonia, electrolyte imbalance, diarrhea are common complications associated with NG tube feeding which in part may be related to faulty feeding technique.Journal of National Institute of Neurosciences Bangladesh, 2018;4(1): 23-27

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