Introduction Enteral nutrition (EN) may be indicated in non-surgical oncology patients if they are undernourished or cannot obtain adequate nutritional intake from the oral route alone.1The choice of feeding tube depends on several factors including gastro-intestinal (GI) tract accessibility, indication for EN and how long EN is required. Local resources such as access to gastroenterology and interventional radiology may also influence the type of tube inserted. The aim of this service evaluation was to determine the type of enteral feeding tube used in this population and their associated complications.
Method We undertook a retrospective review of dietetic records between January 2013 and December 2014 for all patients who required home EN. Data was analysed descriptively. Head and neck and upper GI patients were excluded as this data is collected by separate specialist teams.
Results 17 patients were initiated on EN at home during the data collection period. 12 patients had lung cancer, 2 lymphoma, 2 breast cancer and 1 colorectal cancer. Table 1shows the type and duration of feeding tube used.
All the 11 patients fed for >30 days started with a NGT. 3 were eventually converted to gastrostomies, 4 were clinically unwell and never stable enough to be considered for a gastrostomy, for 1 patient gastrostomy insertion was contraindicated and 3 patients were predicted to respond sooner to treatment and resume oral intake. 10 (59%) patients experienced complications related to their feeding tube. Of those the most common complications reported were with NGTs. 5 patients (29%) had tubes replaced due to blockage or accidental falling out and 3 patients (18%) had repeated difficulties obtaining aspirates or pH of aspirates <5.5 prior to feeding.
Conclusion There was heavy reliance on NGTs as a route of feeding including those requiring feeding for >30 days. It may be more appropriate to consider a gastrostomy insertion for those feeding medium to long term as these are commonly associated with less complications.2We encounter repeated problems with blocked NGTs and difficulties with obtaining gastric aspirates. We therefore need to review our practices in terms of information, training and ongoing support provided to patients in order to reduce these types of complications.
Disclosure of interest None Declared.
Arends J, et al. ESPEN Guidelines on Enteral Nutrition: Non surgical oncology. Clin Nutr. 2006;25:245–259.
Gomes J, et al. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. The Cochrane Library, Issue 11, 2011.
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