-
Nursing TimesSome adults and children are unable to swallow or eat and drink enough. Insertion of a percutaneous endoscopic gastrostomy (PEG) tube may enable long-term feeding, fluid... (Review)
Review
Some adults and children are unable to swallow or eat and drink enough. Insertion of a percutaneous endoscopic gastrostomy (PEG) tube may enable long-term feeding, fluid and/or medication administration. The procedure involves gastroscopy under sedation to identify tube placement site, place the tube and check it has been placed correctly. Serious complications include peritonitis and perforation of the colon. Frequent observations immediately after placement are essential. With good nursing care, complications can be avoided or dealt with promptly.
Topics: Enteral Nutrition; Gastrostomy; Humans; Specialties, Nursing
PubMed: 23167062
DOI: No ID Found -
Radiotherapy and Oncology : Journal of... Jan 2018Tube feeding dependence is a commonly observed debilitating side-effect of curative (chemo-) radiation in head and neck cancer patients that severely affects quality of... (Review)
Review
BACKGROUND
Tube feeding dependence is a commonly observed debilitating side-effect of curative (chemo-) radiation in head and neck cancer patients that severely affects quality of life. Prevention of this side-effect can be obtained using advanced radiation techniques, such as IMRT. For radiotherapy treatment plan optimization, it has become increasingly important to develop prediction models that enable clinicians to predict the risk of tube feeding dependence for individual patients. To develop such a tool, information regarding the most relevant prognostic factors for tube feeding dependence is necessary.
OBJECTIVES
The primary aim of this systematic review, conducted according to PRISMA guidelines, was to identify prognostic factors that are consistently found to be associated with tube feeding dependence at ≥6months after treatment. The secondary aim was to identify prognostic factors found to be associated with tube feeding placement and use at <6months.
DATA SOURCES
Articles were identified through a search in MEDLINE, EMBASE and the Cochrane Library. Approximately 2600 articles were screened and selected by inclusion and exclusion criteria.
RESULTS
Fourteen retrospective studies were identified that fulfilled the inclusion criteria and reported on prognostic factors for tube feeding dependence at ≥6months. The studies reported on patient and disease variables, treatment variables and DVH parameters. Two of these studies reported on a model for tube feeding dependence, one including DVH parameters. Additionally, 18 studies were identified that reported on prognostic factors for tube feeding placement and use at <6months.
CONCLUSIONS
Prognostic factors that were consistently associated with the risk of tube feeding dependence at ≥6months for head and neck cancer patients treated with (chemo-) radiotherapy were DVH parameters, including dose to the larynx, the pharyngeal constrictor muscle inferior and superior, and the dose to the contralateral parotid gland. Furthermore, advanced tumor and nodal stage, pretreatment weight loss, (concomitant) chemotherapy and prophylactic gastrostomy policy were prognostic for tube feeding dependence ≥6months. For tube feeding use at less than 6months, prognostic DVH parameters included dose and volume to the oral mucosa, dose to the contralateral submandibular gland, and also dose to the larynx and the pharyngeal constrictor muscle inferior and superior. Prognostic patients/disease and treatment factors for tube feeding placement and use at less than 6months were similar to the prognostic factors for tube feeding dependence at ≥6months, but also included several unique variables such as the use of narcotics prior to treatment and living alone at the time of treatment.
Topics: Chemoradiotherapy; Enteral Nutrition; Gastrostomy; Head and Neck Neoplasms; Humans; Prognosis; Quality of Life; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Retrospective Studies
PubMed: 28943045
DOI: 10.1016/j.radonc.2017.08.022 -
Nutrients Feb 2023This study investigated whether enteral nutrition by early tube feeding led to changes in clinical parameters compared to tube feeding after 24 h. Starting on 1 January... (Observational Study)
Observational Study
This study investigated whether enteral nutrition by early tube feeding led to changes in clinical parameters compared to tube feeding after 24 h. Starting on 1 January 2021, and following the latest update of the ESPEN guidelines on enteral nutrition, patients with percutaneous endoscopic gastrostomy (PEG) received tube feeding 4 h after tube insertion. An observational study was conducted to analyze whether the new scheme affected patient complaints, complications, or hospitalization duration compared to the previous procedure of tube feeding starting after 24 h. Clinical patient records from one year before and one year after the introduction of the new scheme were examined. A total of 98 patients were included, and of those 47 received tube feeding 24 h after tube insertion, and 51 received tube feeding 4 h after tube insertion. The new scheme did not influence the frequency or severity of patient complaints or complications related to tube feeding (all -values > 0.05). However, the study showed that the length of stay in hospital was significantly shorter when following the new scheme ( = 0.030). In this observational cohort study an earlier start of tube feeding did not produce any negative consequences but did reduce the duration of hospitalization. Therefore, an early start, as suggested in the recent ESPEN guidelines, is supported and recommended.
Topics: Humans; Enteral Nutrition; Gastrostomy; Hospitalization; Hospitals; Retrospective Studies
PubMed: 36904155
DOI: 10.3390/nu15051157 -
Journal of Nutrition in Gerontology and... 2017Dementia is a progressive, debilitating disease that often results in weight loss, malnutrition, and dehydration. Feeding tubes are often prescribed; however, this... (Review)
Review
Dementia is a progressive, debilitating disease that often results in weight loss, malnutrition, and dehydration. Feeding tubes are often prescribed; however, this practice can lead to complications. The purpose of this systematic review was to examine the use of feeding tubes in elderly demented patients from a social ecological perspective. Results indicated that family members often receive inadequate decision-making education. Many health care professionals lack knowledge of evidence-based guidelines pertaining to feeding tube use. Organizational and financial reimbursement structures influence feeding tube use. Feeding practices for patients with advanced dementia is a complex issue, warranting approaches that target each level of the Social Ecological Model.
Topics: Aged; Caregivers; Decision Making; Dementia; Enteral Nutrition; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Quality of Life; Social Environment
PubMed: 28140779
DOI: 10.1080/21551197.2016.1277174 -
Dysphagia 2005Tube feeding is commonly used as a method of giving children nutrition while they are being treated for disease. While this is an effective way of ensuring a child... (Review)
Review
Tube feeding is commonly used as a method of giving children nutrition while they are being treated for disease. While this is an effective way of ensuring a child thrives and grows, research studies and clinical experience have shown that long-term oral feeding difficulties often arise when the child no longer requires tube feeding. This article gives a critical review of the literature on tube feeding and its effect on normal eating and drinking skills. While few studies have followed a rigorous research design, there is enough literature to identify a number of factors which may be implicated in later feeding difficulties and which therefore need further exploration in research studies. These factors include age at which oral feeding commences, medical complications, exposure to taste and textures during sensitive periods, aversive experiences, and different methods of delivering tube feeds.
Topics: Deglutition Disorders; Drinking; Eating; Enteral Nutrition; Gastrostomy; Humans; Infant; Infant Care
PubMed: 15886967
DOI: 10.1007/s00455-004-0025-2 -
International Journal of... Jun 2020To explore possible factors contributing to paediatric tube feeding dependency from the speech-language pathology perspective. Tube feeding dependency can have serious...
To explore possible factors contributing to paediatric tube feeding dependency from the speech-language pathology perspective. Tube feeding dependency can have serious repercussions for children and their families with failed or slow weaning/transitioning from tube to oral feeding, more likely after the age of five. A mixed methods approach was conducted. During the first quantitative phase, an online national survey of speech-language pathologists (SLPs) from the health and non-health sectors was carried out followed by interviews with a subset of the respondents. Forty-three SLPs completed the survey. In the second qualitative phase, 10 participants from the survey were interviewed in depth as to their opinions about why tube dependency occurs. Survey data from phase one were analysed using descriptive statistics and chi square comparisons. Interview data were categorised using thematic analysis. Findings from both methodologies were combined to report the results. Two interlinking meta-themes were identified from the combined data sets. These were: (1) and (2) . The specific results indicated several possible reasons for tube feeding dependency including medical emphasis on weight gain, prolonged nasogastric tube feeding and waiting too long for transition from tube to oral feeding. A lack of integrated care and clinician confidence in non-health settings also appeared to be a factor contributing to tube feeding dependency. Early and ongoing biomedical focus on weight gain affected long-term goals for transitioning leading, subsequently, to tube feeding becoming normalised by school age.
Topics: Child; Child, Preschool; Enteral Nutrition; Female; Humans; Infant; Infant, Newborn; Language Development; Male; Speech-Language Pathology
PubMed: 32366127
DOI: 10.1080/17549507.2020.1754910 -
The Cochrane Database of Systematic... Feb 2013Enteral feeding tubes for preterm infants may be placed in the stomach (gastric tube feeding) or in the upper small bowel (transpyloric tube feeding). There are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Enteral feeding tubes for preterm infants may be placed in the stomach (gastric tube feeding) or in the upper small bowel (transpyloric tube feeding). There are potential advantages and disadvantages to both routes.
OBJECTIVES
To determine the effect of feeding via the transpyloric route versus feeding via the gastric route on feeding tolerance, growth and development, and adverse consequences (death, gastro-intestinal disturbance including necrotising enterocolitis, aspiration pneumonia, chronic lung disease, pyloric stenosis) in preterm infants.
SEARCH METHODS
We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 3), MEDLINE, EMBASE, and CINAHL (to June 2012), conference proceedings, and previous reviews.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials comparing transpyloric with gastric tube feeding in preterm infants.
DATA COLLECTION AND ANALYSIS
We extracted data using the standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by two review authors. We synthesised data using a fixed-effect model and reported typical risk ratio (RR), risk difference (RD), and mean difference (MD).
MAIN RESULTS
We found nine eligible trials in which a total of 359 preterm infants participated. All of the trials contained methodological weaknesses with lack of allocation concealment, absence of blinding of caregivers or assessors, and incomplete follow-up being the major potential sources of bias. The included trials did not detect any statistically significant effects on feeding tolerance or in-hospital growth rates. Meta-analyses found that infants allocated to receive transpyloric feeding had a higher risk of gastro-intestinal disturbance (typical RR 1.48 (95% confidence interval (CI) 1.05 to 2.09); typical RD 0.09 (95% CI 0.02 to 0.17); number needed to treat for an additional harmful outcome (NNTH) 10 (95% CI 6 to 50); six studies, 245 infants) and all-case mortality (typical RR 2.46 (95% CI 1.36 to 4.46); typical RD 0.16 (95% CI 0.07 to 0.26); NNTH 6 (95% CI 4 to 14); six studies, 217 infants). However, the trial that contributed most weight to these findings was likely to have been affected by selective allocation of the less mature and sicker infants to transpyloric feeding. We did not find any statistically significant differences in the incidence of other adverse events, including necrotising enterocolitis, intestinal perforation, and aspiration pneumonia.
AUTHORS' CONCLUSIONS
The available data do not provide evidence of any beneficial effect of transpyloric feeding for preterm infants. Some evidence of harm exists, including a higher risk of gastrointestinal disturbance and mortality, but these findings should be interpreted and applied cautiously because of methodological weaknesses in the included trials.
Topics: Enteral Nutrition; Humans; Infant, Newborn; Infant, Premature; Pylorus; Randomized Controlled Trials as Topic
PubMed: 23450542
DOI: 10.1002/14651858.CD003487.pub3 -
Postgraduate Medicine Feb 2004Tube feeding is an art and a science that is increasingly used in our aging society as more people become physically incapacitated or have dementia. Properly used, tube... (Review)
Review
Tube feeding is an art and a science that is increasingly used in our aging society as more people become physically incapacitated or have dementia. Properly used, tube feeding can be helpful. However, patients should be monitored for tolerance and complications and assessed for a possible return to oral feeding. The joy of eating, one of the pleasures in life, should not be denied if at all possible.
Topics: Aged; Deglutition Disorders; Dementia; Enteral Nutrition; Ethics, Clinical; Food, Formulated; Geriatrics; Humans; Nutrition Assessment; United States
PubMed: 15000061
DOI: 10.3810/pgm.2004.02.1443 -
Journal of the American Geriatrics... Apr 1995To review data about the relationship between pressure sores and (1) nutritional status, (2) nutrient intake, and (3) tube feeding. (Review)
Review
PURPOSE
To review data about the relationship between pressure sores and (1) nutritional status, (2) nutrient intake, and (3) tube feeding.
DATA SOURCES
Medline search of terms associated with "decubitus ulcer" combined with terms associated with "pressure sore" from 1985 through August 1994. Hand review of all issues of the journal Decubitus (now Advances in Wound Care) through June 1994 and the Journal of Parenteral and Enteral Nutrition from January 1987 through May-June 1994. Review of bibliography of pertinent articles. A small survey of experts.
STUDY SELECTION
Articles where the title, Me SH terms, or abstract suggested an examination of the relationship between nutrition and pressure sores, and those suggested by the experts, were reviewed.
DATA EXTRACTION
Study designs were disparate. Results were simply tabulated.
RESULTS
In seven studies, low serum albumin was associated with development or presence of pressure sores; in five it was not. Most measures of nutritional status were not associated with pressure sore outcomes. Poor nutritional intake was associated with poor pressure sore outcome in four of seven studies. Tube feeding was positively associated with presence of pressure sores in one study. Special nutrition support was ineffective in improving pressure sore outcome in a second. Two studies showed better healing in patients receiving high-protein formula: in one, all patients were tube fed; in the other, route of feeding was not stated.
CONCLUSION
Data about the relationship between malnutrition and pressure sores are incomplete and contradictory. No randomized trials of tube feeding as prevention or treatment of pressure sores has been done. Routine use of tube feeding to prevent or treat pressure sores is not clearly supported by data.
Topics: Enteral Nutrition; Humans; Nutrition Disorders; Nutritional Status; Pressure Ulcer; Research Design; Risk Factors; Wound Healing
PubMed: 7706638
DOI: 10.1111/j.1532-5415.1995.tb05822.x -
International Journal of Palliative... Aug 2009Enteral tube feeding for people with advanced dementia who have difficulty swallowing and poor nutritional intake is common. Potential benefits or harms of this practice... (Review)
Review
AIM
Enteral tube feeding for people with advanced dementia who have difficulty swallowing and poor nutritional intake is common. Potential benefits or harms of this practice are unclear and the authors aimed to evaluate the outcomes of this intervention.
METHODS
A full literature review was undertaken in April 2008. Randomized controlled trials (RCTs), controlled clinical trials, controlled before and after studies, interrupted time series studies and controlled observational studies that evaluated the effectiveness of enteral feeding via a nasogastric tube or via a tube passed by percutaneous endoscopic gastrostomy were selected. The study population comprised adults aged 50 and over with a diagnosis of advanced primary degenerative dementia who had poor nutritional intake and/or developed problems with eating and swallowing. The primary outcomes were survival and quality of life (QOL).
RESULTS
No RCTs were identified. Seven observational controlled studies were found; six assessed mortality. There was no evidence of increased survival in people with dementia receiving enteral tube feeding. The other study assessed nutritional outcomes. None of the studies examined the effect on QOL and there was no evidence of benefit in terms of nutritional status or the prevalence of pressure ulcers.
CONCLUSIONS
There is insufficient evidence to suggest that enteral tube feeding is beneficial in people with advanced dementia. Data is lacking on the adverse effects of this intervention.
Topics: Aged; Aged, 80 and over; Deglutition Disorders; Dementia; Enteral Nutrition; Female; Gastroscopy; Gastrostomy; Humans; Intubation, Gastrointestinal; Male; Malnutrition; Middle Aged; Patient Selection; Randomized Controlled Trials as Topic; Research Design; Severity of Illness Index; Treatment Outcome
PubMed: 19773704
DOI: 10.12968/ijpn.2009.15.8.43799