Newsletter

[ Vol. 12 No. 1 ] (January - April 2011 )
Complications of enteral nutrition

Krishnan Sriram
Department of Surgery, John H Stroger Jr Hospital of Cook County, Chicago, Illinois, USA

INTRODUCTION

Despite its perceived simplicity, enteral nutrition (EN) can be associated with significant complications, which can be minimized by the involvement of an organized nutrition support team.

COMPLICATIONS OF EN ARE AS FOLLOWS
Mechanical
Nasogastric tubes, especially large bore types, case rhinitis, erosion of nares, maxillary sinusitis, and esophageal and gastric erosions. They are associated with an increased incidence of gastroesophageal reflux and pulmonary aspiration/pneumonitis, Soft bore smaller sized nasoenteral tubes can be malpositioned in the tracheobronchial tree leading to disastrous complications. Gastrostomy and jejunostomy tubes are associated with insertion related and maintenance-related complications. Leakage of gastric or intestinal contents around the tube site is a nursing nightmare.

Infectious
Bacterial contamination of enteral feeding occurs more frequently with kitchen-prepared diets especially if not stored appropriately or used immediately. Aspiration pneumonitis can be minimized by positioning the patient in a semi-recumbent position. Routine checking of gastric residues, though often practiced, may not even be necessary.

Metabolic
Dehydration occurs if adequate free water is not given. Electrolyte imbalances (including Mg and P) are preventable. Aggressive and rapid sequential increase in the rate of feeding, resulting in overfeeding, should be avoided. Hyperglycemic nonketotic coma is a preventable complication. Non-commercial kitchen prepared feeding often does not provide the expected macro and micronutrients.

Gastrointestinal
Constipation occurs due to decreased water intake and lack of adequate fiber. Diarrhea occurs in malnourished and critically ill patients on EN, not necessarily because of the feedings per se. Once spurious diarrhea due to fecal impaction is ruled out, and other causes such as osmotic load from medications, infections, etc have been rule out, treatment consists of providing more fiber.

CONCLUSIONS
Providing EN as part of a specialized nutritional support plan benefits patients. Complications of EN are no less common or no less serious than those customarily associated with parenteral nutrition.

From   
PENSA 2009
“Energizing Nutrition Support Practice for Life”
June 5-7 2009, Shangri-La Hotel, Kuala Lumpur, Malaysia 
Page: 41