Tube Feeding Potential Problems/Complications

Problem Symptoms Immediate Action Possible Causes Prevention Aspiration Heartburn or vomiting Stop the tube feeding P erson improperly positioned for Do not administer feeding if stomach feels full, is Coughing, choking Notify health care feeding distended or if person is vomiting Difficulty breathing and/or practitioner Tube movement/out of place Follow directions for tube feeding rate and feeding shortness of breath with or Notify designated agency Swallowing disorder method (per health care practitioner) without chest pain, loud, personnel Poor gag reflex Examine feeding tube for placement prior to feeding, or wet breath sounds Gastroesophageal reflux disease at specified intervals and make sure tube is secured Rapid heart rate (GERD) per instructions Agitation Delayed stomach emptying Position properly for feeding (per health care practitioner)

Constipation Infrequent, hard stools Increase fluids Inadequate fluid intake and/or fiber Fiber and fluids as ordered by health care practitioner Abdominal bloating, Use stool softener or intake Medications (stool soften er or laxative) as ordered by cramping/pain laxative as ordered by Side effects from medication health care practitioner health care practitioner Inactivity Maintain activity level as recommended by health care Notify designated agency Bowel obstruction professional and as tolerated personnel Decreased bowel motility Call health care practitioner if: a)hard, infrequent stools are combined with leakage of liquid stool, b)there is no bowel movement in 2-3 days, c)vomiting, d)stomach bloating, e)cramping Diarrhea Abdominal pain & cramping Slow down tube feeding Intolerance to tube feeding formula Follow directions for tube feeding rate and feeding Loose stools Follow written Allergy to tube feeding formula method (per health care professional) instructions from health Rate too high Follow protocol for tube feeding hygiene care professional and Contaminated formula Report any recent antibiotic use notify health care Gastrointestinal disorder professional if indicated Adverse medication side effects Notify designated agency (particularly antibiotics) personnel

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Problem Symptoms Immediate Action Possible Causes Prevention Fluid or Rapid weight loss or gain Stop tube feeding for Increased or decreased urine output Administer tube feedings and flushes as ordered Electrolyte Edema (swelling) shortness of breath Inadequate fluid intake Monitor intake and output Thirst Report all symptoms to Excessive fluid loss from vomiting, Monitor weight Imbalance Shortness of breath health care professional diarrhea Shakiness, tremors, muscle Notify designated agency cramps, numbness, personnel tingling sensations Heart palpitations Tiredness, weakness Loss of coordination GI Bleeding Bright red blood in or on Notify health care Bleeding in GI tract between Good management/treatment of vomiting, diarrhea stool professional mouth and anus and/or constipation Black, tarry stool Notify designated agency Irritation from feeding tube Make sure tube is secured per instructions Vomit that looks like coffee personnel grounds Blood from and/or around the tube Hyperglycemia Nausea Follow protocol Uncontrolled diabetes Have parameters from health care professional in place (high blood Weakness (parameters) previously Excessive stress from illness Monitor blood sugars as ordered Headache determined by health Certain medications sugar) Anxiety care professional Blurred vision Call health care Excessive hunger, thirst, professional if blood urination sugar results are above parameters Notify designated agency personnel Hypoglycemia Shaking Follow protocol Diabetes Administer tube feedings as ordered (low blood sugar) Nausea (parameters) previously Certain medications Have parameters from health care professional in place Pale facial color determined by health Tube feedings not administered as Monitor blood sugars as ordered Weakness, tiredness care professional ordered Palpitations Call health care Sweating professional if blood Anxiety sugar results are below Dizziness parameters Blurred vision Notify designated agency Headache personnel Blood sugar below 60

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Problem Symptoms Immediate Action Possible Causes Prevention Nausea/Vomiting Nausea and/or vomiting Stop tube feeding Recently began tube feedings (not Follow directions for tube feeding rate and feeding Dry heaves/retching Follow written accustomed to it yet) method ( per health care professional ) Abdominal distension, instructions from health Intolerance to tube feeding formula Follow protocol for tube feeding hygiene bloating, cramping care professional and Allergy to tube feeding formula Examine feeding tube for placement prior to feeding, or Cold sweat notify health care Rate too high at specified intervals professional if indicated Contaminated formula Position properly for feeding and after feeding (per Notify designated agency Tube displaced health care professional) personnel Person improperly positioned for Check stomach residuals (G-tube) prior to feeding (per feeding health care professional) Gastrointestinal issues Constipation Bowel obstruction Noxious odors Medication intolerance Upper respiratory illness (coughing, post nasal drip) Skin Site Skin irritation in area around Stop tube feeding Improperly fitting tube Provide care to the insertion site as instructed Irritation/Tube tube Clean skin Excessive tugging at tube Secure tube as instructed Pain in area Clamp feeding tube above Accidental injury to tube Avoid excessive rough handling of tube Leaking Foul odor area of injury Defective tube Avoid using sharp objects around tube Leakage from feeding tube Follow written or around feeding tube instructions from health care professional and notify health care professional if indicated Notify designated agency personnel Tube Tube outside of body or not Stop tube feeding Tube not properly secured Check placement of feeding tube at designated intervals Displacement in proper position Notify health care Accidental or excessive pulling of Choking and/or difficulty professional tube breathing Notify designated agency Balloon (which holds tube in Nausea, vomiting, personnel place) deflated abdominal pain Excessive vomiting

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Problem Symptoms Immediate Action Possible Causes Prevention Tube Inability to flush tubing Check that clamp on Tubing clamp closed Open clamp during flushing, feeding, and medication Obstruction/ Bulging of tube during flush tubing is open, if yes Poor medication administration administration or feeding see below technique (meds not completely Administer medications per instructions Blockage Stop tube feeding crushed or dissolved) Flush per instructions (clogged tube) Follow written Inadequate flushing of tube instructions for flushing Defective tubing from health care professional Notify health care professional if flush unsuccessful Notify designated agency personnel

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