Tube Feeding In Patients Research Articles

No. 146 A Comparison Regarding ADL Recovery Between Percutaneous Endoscopic Gastrostomy and Nasogastric Tube Feeding in Patients With Dysphagic Stroke in a Convalescent Rehabilitation Ward

No. 146 A Comparison Regarding ADL Recovery Between Percutaneous Endoscopic Gastrostomy and Nasogastric Tube Feeding in Patients With Dysphagic Stroke in a Convalescent Rehabilitation Ward

The effectiveness of ultrasonography in verifying the placement of a nasogastric feeding tube in patients with low consciousness at an emergency center

Background: This study was designed to compare the effectiveness of using auscultation, pH measurements of gastric aspirates, and ultrasonography as physical examination methods to verify nasogastric tube(NGT) placement in emergency room patients with low consciousness who require NGT insertion. Methods: The study included 47 patients who were all over 18 years of age. In all patients, tube placement was verified by chest X-rays. Auscultation, pH analysis of gastric aspirates, and ultrasonography were conducted on each patient in random order. The mean patient age was 57.62±17.24 years, and 28 males (59.6%) and 19 females (40.4%) were included. The NGT was inserted by an emergency room resident. For pH testing, gastric aspirates were dropped onto litmus paper, and the resulting color of the paper was compared with a reference table. Ultrasonography was performed by an emergency medicine specialist, and the chest X-ray examination was interpreted by a different emergency medicine specialist who did not conduct the ultrasonography test. The results of the auscultation, gastric aspirate pH, and ultrasonography examinations were compared with the results of the chest x-ray examination. Results: The sensitivity and specificity were 100% and 33.3%, respectively, for auscultation and 86.4% and 66.7%, respectively, for ultrasonography. Kappa values were the highest for auscultation at 0.484 compared to chest x-rays, followed by 0.299 for ultrasonography and 0.444 for pH analysis of the gastric aspirate. The ultrasonography has a positive predictive value of 97.4% and a negative predictive value of 25%. Conclusions: Ultrasonography is useful for confirming the results of auscultation after NGT insertion among patients with low consciousness at an emergency center. When ultrasound findings suggest that the NGT placement is not gastric, additional chest X-ray should be performed.

Survival Effect of Tube Feeding in Patients with Advanced Dementia and Comorbidities

Patients suffering from advanced dementia who have difficulties in eating and swallowing are often tube fed (TF). They suffer, on most occasions, from additional diseases. The effect of tube feeding in advanced dementia patients is controversial and is largely discussed in the medical literature. The purpose of the present study, is to report the effect of tube feeding on the survival time in patients with advanced dementia who suffered from additional diseases. One hundred and forty nine patients with Functional Assessment Stage of Alzheimer Disease (FAST) stage 5>, hospitalized in skilled geriatric nursing department between July 2008 and December 2011 were included in the study. Oral and tub feeding was decided following the evaluation by speech therapists at admission. 99 (66.5%) of the patients were tube fed and 50 (33.5%) received oral feeding at admission. The mean age was 80 ± 11. Sixty four percent of the patients were admitted from general hospitals. Comorbidities were significantly higher in the tube fed group, median survival time was 164 days. The median survival time of the OF group was 78 days (χ2 = 0.94; p = 0.33). Prevalence of tube feeding increased significantly from 53.85% to 90.9% in patients with 3 risk factors such as pressure ulcers, low Hgb and low BMI. The survival time of the tube fed patients was longer compared to patients who were orally fed. Tube feeding in patients with dementia continues to be controversial, and additional researchable data are helpful in the decision to insert a tube.

Feeding tubes in patients with dementia

Eating problems afflict up to 86% of patients with advanced dementia, and approximately 39% of these patients die within 6 mo of developing these problems. More than one in three patients with advanced dementia living in nursing homes is fed via feeding tube. This paper reviews the evidence for the use of feeding tubes in patients with advanced dementia as well as information on logistic and systems issues that may explain the high prevalence for the use of feeding tubes in this setting.

Jejunostomy tube feeding in patients undergoing esophagectomy

Surgical jejunostomy tubes are a routine part of elective esophagectomies in patients with carcinomas and provide a route for nutritional support in those who experience complications. We wished to determine how frequently oral intake is delayed and the amount of nutrition delivered via the jejunostomy tube. We reviewed the charts of all adults undergoing esophagectomy for carcinoma between January 2000 and June 2008. We determined the proportion of patients unable to resume oral nutrition after 8 days and the amount of nutrition delivered in each of the 8 days. In all, 111 patients underwent elective esophagectomy for carcinoma, and 103 had a jejunostomy tube placed. The mean age was 67 ± 10.8 years. The median time to oral intake was 7 (interquartile range 7-11) days. Seventy-four (67%) patients resumed oral intake within 8 days. The mean nutrition delivered by jejunostomy within the first 8 days as a percentage of the target was 45.6% (95% confidence interval 41.2%-49.9%). Six (5.4%) patients experienced complications attributable solely to the jejunostomy tube; 3 (2.9%) required surgery. Forty (38.8%) patients had abdominal issues serious enough to warrant delaying the progression of feeding. Two-thirds of patients undergoing elective esophagectomy were tolerating oral intake by the end of the eighth postoperative day, and less than half of the target nutrition was delivered over the first 8 days. We now selectively place surgical jejunostomy tubes in patients undergoing elective esophagectomies.

The management of dysphagia in esophageal adenocarcinoma patients undergoing neoadjuvant chemotherapy: Can invasive tube feeding be avoided?

e15034 Background: Neoadjuvant chemotherapy is an accepted standard for locally advanced esophago-gastric adenocarcinoma. However the dysphagia frequently associated with this condition may interfere with patient tolerance of neoadjuvant chemotherapy. Surgical or endoscopic invasive tube feeding (ITF), including stents, is a commonly employed strategy to maintain nutritional support however it can cause significant morbidity in its own right. We sought to determine if an approach of careful dietary counseling and fast-tracked neoadjuvant chemotherapy can obviate the need for ITF. Methods: Pts undergoing neoadjuvant chemotherapy (DCF or ECF Q3 weeks x3 or FLOT Q2weeks x4) for locally advanced (cT3 and/or N+) esophageal or EGJ adenocarcinoma at a single institution from 3/07-9/12 were identified from a prospective database. All received dietary counseling and were closely monitored for signs/ symptoms of malnutrition with serial (baseline/pre-surgery) Body Mass Index (BMI), albumin, dysphagia scores (DS: 0 best - 4 worse), and quality of life (FACT-E). We assessed the response of dysphagia and nutritional status to neoadjuvant treatment and the need for ITF. Data presented as median (Interquartile Range) or median (±SD), paired t-test or Wilcoxon signed ranks test determined significance (*p=0.05). Results: Of 130 patients undergoing neoadjuvant chemotherapy 78 had dysphagia scores of 2 or greater, most of whom received DCF (91%). Overall the dysphagia improved in 75/78 (96%) from a DS of 3 (2-4) to 0 (0-1)*. This was associated with an increase in FACT-E QoL scores (117±23 to 140±20)*. Weight (Kg)(70±22:69±24), BMI (24.5±8 to 23.9±7), and Albumin (40±5 to 37±4) were maintained. Only one patient required a stent, and none a jejunostomy, or gastrostomy. Conclusions: Appropriately timed neoadjuvant chemotherapy with a highly effective regimen rapidly restores normal swallowing, maintains nutritional status, and obviates the need for stenting or invasive tube feeding in patients with significant dysphagia from esophageal adenocarcinoma.

重症心身障害児（者）における経管栄養時の適切な姿位の検討

重症心身障害児（者）における経管栄養時の適切な姿位の検討

PC-FACS

PC-FACS

Feeding Tubes in Patients with Advanced Dementia

Some surrogate decision makers opt for placing percutaneous endoscopic gastrostomy (PEG) tubes to prolong life in patients with advanced dementia.

Effect of step-by-step interactional health education model on the quality of home care in tube feeding patients after stroke

Objective To evaluate the benefits of step-by-step interactional health education model in improving the home care quality in tube feeding patients after stroke.Methods Totals of 60 main home care givers of patients who received tube feeding after stroke were randomly divided into 2 groups.The test group was given step-by-step interactional health education model,which main home care givers received the health education about the relevant knowledge and demonstration operation process in the 1st ～5th day,operation notes and exercise in 6th-10th day,demonstrated the notes and finished the operation under the help of nurses in 11th ～15th day; while the control group was given standard health education model.Then,the skill of tube feeding,overall nursing knowledge,and patients' satisfaction on the nursing of two groups were observed on the 15th day,and the situation of tube indwelling was observed during 28 days after discharge by phone.Results The scores of nursing knowledge and tube feeding skills of test group were ( 8.23 ± 1.0l ) and( 38.07 ± 2.63 ),and those of the control group were ( 5.73 ± 0.98 ) and ( 24.53 ±3.40 ),and the difference was statistically significant ( t=9.75,17.25,respectively; P ＜ 0.01 ).The situation of tube indwelling of test group during 28 days after discharge by phone was significantly better than that of control group ( P＜ 0.01 ).Conclusions The step-by-step interactional health education model can improve the quality of home care in tube feeding patients after stroke,promote the patients satisfaction of nursing skills and procedures. Key words: Stroke; Step-by-step interactional health education; Tube feeding; Home care

Endoscopic solutions to challenging enteral feeding problems

Enteral nutrition support is often required in patients who are unable to meet their own nutritional requirements. Endoscopists play a key role in the placement of enteral feeding catheters. This review focuses on the recently published solutions to common problems encountered during endoscopic placement of enteral feeding devices. Case reports and case series describe solutions for overcoming common problems encountered during the placement of enteral feeding devices. Transnasal techniques can simplify nasojejunal tube placement, whereas deep enteroscopy techniques provide more reliable jejunostomy placement. Endoscopic ultrasound can help when transillumination is not possible or in the setting of postsurgical anatomy like Roux-en-Y. Laparoscopic-assisted procedures are useful when endoscopic techniques have failed in adults or in select high-risk pediatric patients. The American Society for Gastrointestinal Endoscopy and the American Gastroenterology Association both published comprehensive guidelines that outline the indications, contraindications, technical aspects of feeding catheter placement, and complications. Advances in endoscopic techniques, including deep enteroscopy, endoscopic ultrasound, ultra-slim transnasal endoscopes and laparoscopic-assisted procedures, have enabled endoscopists to successfully place enteral feeding tubes in patients who previously required open procedures.

Exercise for Better ALS Management?

Exercise for Better ALS Management?

Clinical evaluation of percutaneous endoscopic gastrostomy tube feeding in Japanese patients with dementia

The aim of this study was to clinically evaluate percutaneous endoscopic gastrostomy (PEG) tube feeding of elderly Japanese patients with dementia. The records of the 155 patients with dementia who underwent PEG in Juntendo Tokyo Koto Geriatric Medical Center were reviewed for pertinent clinical data, including diagnosis of dementia, place of stay before and after hospitalization, as well as survival rate, albumin levels, and incidence of aspiration pneumonia (AP) before and 6 months after PEG feeding. The latter three data of these patients were compared with those of 106 patients with dementia fed through a nasogastric (NG) tube. Alzheimer's disease and vascular dementia were predominant. Fifty-three percent of the patients were admitted from their home; the number of discharges to homes decreased to 21.2%. The mean (SD) of the albumin levels was 2.9 (0.4) g/dl before feeding and 2.9 (0.6) g/dl after 6 months. Among the patients with AP before PEG tube feeding, 51.6% had an AP recurrence. Conversely, AP occurred in 9.4% of the patients without AP before feeding. The patient survival rate was higher by 27 months when using PEG tube than when using an NG tube. PEG tube feeding in patients with dementia leads to preservation of status for a few years. Compared with NG tube feeding, PEG tube feeding did not induce AP due to impairment of intact swallowing function, and was associated with higher survival rate of approximately 2 years. However, PEG tube feeding does not seem to promote home medical care.

Glycaemic control during enteral tube feeding in patients with diabetes who have had a stroke: a twice‐daily insulin regimen

AbstractUncontrolled hyperglycaemia has been a problem in patients with diabetes mellitus who have had a stroke and require enteral tube feeding in our hospital. There is a sustained glucose rise as opposed to the postprandial peaks of normal eating. In the absence of national guidelines, we tailored an insulin regimen for our inpatients. In this observational study we evaluated the effectiveness of this regimen for glycaemic control in these patients.Inpatients with diabetes receiving enteral feeding were given insulin twice daily. The initial dose was calculated from estimated carbohydrate‐to‐insulin ratio, feed carbohydrate concentration, infusion rate and duration, and adjusted according to capillary glucose (target range: 6–12mmol/L).Twenty‐four patients required enteral feeding; average age 72 years and weight 73.8kg. The median (range) feed carbohydrate concentration was 12.3(12.3–20.1)g/100ml; the final feed infusion rate 75(50–100)ml/hr; feed duration 20(10–24)hours/day; and carbohydrate‐to‐insulin ratio 10(6–10). Initial insulin doses ranged from 12–32units/day. Target capillary glucose range was achieved in 17 patients. Of the seven patients who did not achieve the target range, four pulled out their feeding tubes too early, one had hyperosmolar state, one died of aspiration pneumonia and one had a very complex feeding regimen. There were no hypoglycaemic events.This study has confirmed that a simple twice‐daily insulin regimen for patients with diabetes mellitus who require enteral tube feeding is safe and effective for most patients. The importance of frequent blood glucose monitoring in these patients cannot be over‐emphasised. Copyright © 2012 John Wiley & Sons.

Superior Mesenteric Artery Syndrome in Intellectually Disabled Children

Superior mesenteric artery syndrome (SMAS) is a rare cause of small intestinal obstruction in pediatric patients. Children with intellectual disabilities are a challenging patient population in which to make this diagnosis. The goal of this study was to determine the frequency, presenting symptoms, and outcomes of SMAS in intellectually disabled and non-intellectually disabled children. Retrospective chart review of pediatric patients with SMAS admitted to Penn State Hershey Children's Hospital between January 1999 and July 2010. Sixteen children with SMAS were identified. The majority were male (n = 9) and more than two thirds had an intellectual disability (n = 11). Presenting symptoms were similar between groups, but 78% (7/9) of intellectually disabled patients who had a gastrostomy tube presented with feeding intolerance. Although intellectually disabled patients had a higher number of comorbidities and the number of health care visits before diagnosis was higher, this did not reach statistical significance. There were also no significant differences in length of symptoms before diagnosis and amount of weight loss. However, the weight-for-age percentiles in intellectual disabled children were significantly lower in those without an intellectual disability (9.09 [20.31] vs 48 [20.19], respectively, P ≤ 0.001). Seventy-five percent of patients responded favorably to conservative treatment, but 36% (4/11) of intellectually disabled patients required multiple treatments before there was an improvement in their condition. Superior mesenteric artery syndrome was found more often in children with an intellectual disability. These data highlight the need to consider SMAS if there is difficulty tolerating gastrostomy tube feedings in patients with weight-for-age percentiles less than 5%.

The use of biodegradable (SX-ELLA) oesophageal stents to treat dysphagia due to benign and malignant oesophageal disease

Biodegradable (BD) oesophageal stents have been available commercially only since 2008 and previous published research is limited. Our aim was to review the use of BD stents to treat dysphagia in benign or malignant oesophageal strictures. Patients were identified from a prospective interventional radiological database. BD stents were inserted radiologically under fluoroscopic control. Between July 2008 and February 2011, 25 attempts at placing SX-ELLA biodegradable oesophageal stents were made in 17 males and five females, with a median age of 69 (range = 54-80) years. Two patients required more than one BD stent. Indications were benign strictures (n = 7) and oesophageal cancer (n = 17). One attempt was unsuccessful for a technical success rate of 96% with no immediate complications. Clinical success rate was 76%. Median dysphagia score before stent insertion was 3 (range = 2-4) compared to 2 (range = 0-3) after stent insertion (p = 0.0001). BD stents provide good dysphagia relief for the life time of the stent. They may help avoid the use of feeding tubes in patients having radical chemoradiotherapy or awaiting oesophagectomy. They do not require removal or interfere with radiotherapy planning via imaging. However, the reintervention rate is high after the stent dissolves.

Prophylactic Feeding Tubes for Patients with Locally Advanced Head-and-Neck Cancer Undergoing Combined Chemotherapy and Radiotherapy—Systematic Review and Recommendations for Clinical Practice

This work aimed to determine the benefits and risks of prophylactic feeding tubes for adult patients with squamous cell carcinoma of the head and neck who receive combined chemotherapy and radiotherapy with curative intent and to make recommendations on the use of prophylactic feeding tubes and the provision of adequate nutrition to this patient population. A national multidisciplinary panel conducted a systematic review of the evidence and formulated recommendations to guide clinical decision-making. The draft evidence summary and recommendations were distributed to clinicians across Canada for their input. No randomized controlled trials have directly addressed this question. Evidence from studies in the target population was limited to seven descriptive studies: two with control groups (one prospective, one retrospective) and five without control groups. Results from ten controlled studies in patients treated with radiotherapy alone were also reviewed. The available evidence was insufficient to draw definitive conclusions about the effectiveness of prophylactic feeding tubes in the target patient population or to support an evidence-based practice guideline. After review of the evidence, of guidelines from other groups, and of current clinical practice in Canada, the multidisciplinary panel made consensus-based recommendations regarding comprehensive interdisciplinary clinical care before, during, and after cancer treatment. The recommendations are based on the expert opinion of the panel members and on their understanding of best clinical practice.

Nutritional Considerations in Tube Feeding Patients

Nutritional Considerations in Tube Feeding Patients

If an endoscope is passed through a stenosis it is not always sure that a peg tube can be passed as well. Case report

Background: Tube feeding for patients with oro-pharyngeal dysphagia, caused by head and neck cancer, via percutaneous endoscopic gastrostomy (PEG) is worldwide the preferred method of choice. PEG tubes might be placed by using the pull-through or push-wire, the so called oral techniques or by a Seldinger method according to Russell. The original pull-through technique is most often used. Endoscopiests are at the opinion that a stenosis where a gastroscope might be passed a PEG tube is easily pulled trough.

Efficacy of Tube Feeding in Binge‐Eating/Vomiting Patients

In many binge-eating/vomiting patients, abstinence could not be obtained from classical treatments. Since the authors showed that tube feeding (TF) reduced such episodes in anorexia nervosa (AN)-hospitalized patients, they carried out a randomized trial on the efficacy of TF plus cognitive behavioral therapy (CBT) vs CBT alone in AN and bulimia nervosa adult outpatients. The authors randomly assigned 103 ambulatory patients to receive 16 sessions of CBT alone (n = 51) or CBT plus 2 months of TF (n = 52). The main goal was abstinence of binge-eating/vomiting episodes. Other criteria were gains in fat-free mass and muscle mass improvements in nutrition markers, and quality of life (SF-36 Health Survey), depression (Beck Depression Inventory), and anxiety (Hamilton Anxiety Rating Scale) scores. Evaluations were performed at 1, 2 (end of treatment), 5, 8, and 14 months (analysis of variance). TF patients were rapidly and more frequently abstinent at the end of treatment (2 months) than the CBT patients: 81% vs 29% (P < .001). Fat-free mass, biological markers, depressive state (-58% vs -26%), anxiety (-48% vs -15%), and quality of life (+42% vs +13%) were more improved in the TF group than in the CBT group (P < .05). One year later, more TF patients remained abstinent (68% vs 27%, P = .02); they were less anxious, were less depressed, and had better quality of life than the CBT patients (P < .05). TF combined with CBT offered better results than CBT alone.