Nasogastric tube feedings. Practical considerations in prescription and evaluation

Complications occurring during enteral nutrition support: a prospective study

A review of 253 patients treated with enteral nutrition support via tube feedings is presented for the purpose of evaluating the incidence of complications. Thirty patients, (11.7%) experienced either gastrointestinal, (6.2%) mechanical (3.5%), or metabolic (2.0%) complications. The recognition and treatment of such complications are discussed and it is concluded that tube feedings are safely tolerated by most patients; however, constant attention must be exerted to either avoid or recognize such complications.

Recent advances in surgery of the larynx and trachea

Recent advances in surgery of the larynx and trachea have occurred in the general areas of diagnosis, pretreatment nutritional therapy, surgical technique, and reconstruction. In diagnosis the routine use of the flexible fiberoptic laryngoscope in the office and the use of computerized tomography have been valuable. The addition of enteral and parenteral nutrition therapy in selected patients with laryngeal cancer has been an advance. In the area of surgical technique, section of the recurrent nerve for the treatment of abductor laryngeal spastic dysphonia has proved successful. In the area of reconstruction the use of the epiglottic flap for repair of the larynx after near-total laryngectomy for glottic cancer and the use of the pectoralis major myocutaneous flap for one-stage pharyngoesophageal reconstruction have been significant advances. An increase in the number of patients with chronic lung disease has created a new interest in tracheal fenestration.

Enteral and parenteral nutrition in patients with head and neck cancer

Head and neck cancer patients present with special problems in nutritional homoeostasis because of local phayngeal discomfort and obstruction and difficulty with deglutition due to either the neoplasm or the surgical alterations in the upper aerodigestive tract. Pretreatment malnutrition and vitamin deficiency are only compounded by the nutritional stress imposed by radiation and surgery. Reduced wound complications occur if the patients are nutritionally replenished before treatment. While nasogastric feedings will suffice in many patients, rapid nutritional restoration by this method is limited, and positive nitrogen balance may be difficult to achieve in the severely malnourished patient. Intravenous hyperalimentation offers a rapid and efficacious alternative in selected cases. The case histories of two patients are presented to illustrate these concepts.

Subjective distresses of nasogastric tube feeding

Health care professionals assume that tube feeding is an unpleasant, distressing experience for patients, which is only partially substantiated by experience. Thirty patients were interviewed via a tube feeding and hospital experience checklist (a 47-item interview schedule). Common experiences were operationally defined as those felt by at least 50%; subjectively distressful experiences were those identified by patients as causing distress. The most common and most distressful experiences of nasogastric tube feeding were: sensory irritations and sensory deprivation. The psychosensory irritation experiences were: thirst, sore nose or throat, dry mouth, runny nose, a tube in the nose, taking food through a tube, breathing through the mouth, breathing with a tube in the nose, taking food in a treatment type container, and taking food with a different texture and smell than usual. The psychosensory deprivation experiences were: an unsatisfied appetite for certain foods, deprivation of tasting, chewing, swallowing food, and drinking liquids, limited mobility, and deprivation of regular food. Except for burping, gastrointestinal symptoms were not common though they were usually distressful. This information has been used to develop teaching programs which are being tested for effectiveness in reducing distress associated with nasogastric tube feeding.