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Nursing Home Staff Must Pay Special Attention To Avoid Complications When Caring For Patients Dependent On Feeding Tubes

feeding-tube1Many nursing home residents require feeding tubes because of illness or weakness.  In order to maintain a resident’s strength and health, a feeding tube can be used to either supplement eating by the mouth or completely replace a resident’s meals.

Good nutritional habits are especially important for residents who are already suffering from illness, trauma, or weakness.  Eating a well-balanced diet gives residents strength and may help them fight infection.

 When a nursing home resident’s dietary needs cannot be met by eating a well-balanced diet, the resident might be placed on alternative means of nutritional support such as a feeding tube.

One of the most common reasons for a feeding tube is cancer, especially of the head, neck, stomach, and esophagus.  Other conditions such as Crohn’s disease, ALS, stroke, surgical bowl removal might also require a feeding tube.

A feeding tube might be needed if a resident has:

  • Severe nutritional problems
  • Severe dehydration
  • Aspiration pneumonia on several occasions
  • Great fear of suffocation from choking or aspiration

A feeding tube can be either a short-term or long-term solution for a resident’s nutritional needs.  If the nursing home staff is concerned about a resident’s nutritional health and well-being, a doctor and nutritionist will determine where the feeding tube will be placed (through the nose or directly into the stomach) and the feeding formula.  Usually, a feeding tube is not employed unless all attempts at feeding by mouth have been tested.

A doctor will decide the best plan for feeding based on the resident’s gastrointestinal function, physical capability, and degree of cooperation.  The feeding formula can range from blended food products to commercial formulas.  There are several types of feeding tubes: G-Tube, PEG (percutaneous esophago-gastronomy, placed directly into stomach), J-Tube (Jejunostomy Tube, placed directly into small bowel and stomach), NG-Tube (Nasogastric Tube, placed through nose).

The G-Tube is surgically placed into the abdominal wall, below the rib cage and goes directly into the stomach.  It is a convenient delivery route for long-term feeding and can be easily replaced.  The J-Tube is surgically placed into the upper section of the small intestine (jejunum).  This tube bypasses the stomach and feeds directly into the intestinal tract.  The NG-Tube is placed in a nostril, down the pharynx, through the esophagus, and into the stomach.  It is usually used for short-term feeding.  The placement of the tube must be checked before each feeding.

There are also several methods for formula delivery: bolus/syringe method, gravity drip method, and pump feeding.  The bolus/syringe method uses a syringe attached to the feeding tube.  The formula is poured into the syringe and flows into the tube.  The gravity drip method uses a gravity feeding bag.  The flow rate (determined by a doctor) can be controlled, and the bags must be changed every 24 hours to prevent bacteria growth.  The pump feeding method is controlled by a battery or electrical operated device set to control the rate of infusion.

Complications with feeding tubes can occur, so nursing home staff must closely monitor residents’ feeding tubes.  The feeding tube can become loose, and aspiration can still occur with a feeding tube in place.  Therefore, it is important that the head remain above the level of the tube.  In addition, care must be taken to prevent the growth of bacteria in feeding tube formula.  Some bags have an ice pouch on the outside to keep the formula fresh, and bags must usually be changed every 24 hours.

Nursing home staff must also take extra precautions to prevent infection of the feeding tube and cause the resident further health problems.  For feeding tubes that are surgically placed, greater care is required during the first week the tube is in place to prevent infection and prevent the tube from pulling away from the abdominal wall.  For tubes placed directly into the stomach, care must be taken to keep the skin surrounding the tube clean and dry, and in some instances, covered with gauze.  Furthermore, gastric leakage can occur with the stomach feeding tubes.  This is problematic because the gastric juices are acidic and can cause skin irritation.

Most commercial feeding formulas are not very thick and do not leave a reside so that they do not clog the tube.  The nursing home staff must still take precautions to prevent clogging including flushing the tube with water before and after feeding.

Many nursing home residents are at risk for illness and injury, so it is important to keep their strength up.  Therefore, feeding tubes are an important method to help maintain residents’ health and well-being.  It is important to know that additional complications can occur with feeding tubes.  If your family member is a victim of feeding tube complications, I would honor the opportunity to discuss your situation.  As always, our legal services are completely free if there is no recovery for you.  Speak to our experienced nursing home lawyers today.  (888)424-5757.

 

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