Complications of enteral nutrition support

  1, improper placement of feeding tube: this complication mainly occurs in the nasogastric or nasoduodenal and jejunal placement, when the feeding tube is mistakenly placed into the trachea, bronchus, serious cases can penetrate the lung tissue and dirty pleura, causing pneumothorax, hemopneumothorax, pus, tracheal pleural fistula and pulmonary hemorrhage. Once the feeding tube is found to be misplaced, the catheter should be pulled out immediately and observed for pneumothorax, hemothorax and other manifestations and treated accordingly in a timely manner. The method of prevention is careful operation, strict intubation procedures and principles, nasal feeding tube (nasogastric or nasogastric tube) after placement, suction, gas injection auscultation or X-ray, etc. to confirm whether the tip of the catheter is in the digestive tract.  2, nasal, pharyngeal and esophageal injury: nasal and pharyngeal discomfort or injury is mainly due to long-term placement of thick and rigid feeding tube, which compresses the wall of the nose, pharynx or esophagus, causing mucosal erosion and necrosis. Therefore, soft, fine caliber polyurethane and silicone catheters should be used for intubation, and the operation should be carefully and gently, and the cause should be identified when resistance is encountered. Other ways can also be used, such as enteral nutrition through gastrostomy or jejunostomy.  3.Feeding tube blockage: The common reasons for feeding tube blockage are small inner diameter of feeding tube, viscous nutrition solution, adherence of meal residue and fragment of incomplete crushed tablets in the lumen of the tube or coagulation of the mixture caused by incompatible drugs and meals. The main measure of prevention is to flush with 20-50ml of water for each infusion or every 2-8 hours of infusion, and flush at any time if resistance is found to be large. Choose the feeding tube of suitable caliber and apply nutrition pump for continuous and uniform infusion.  4, feeding tube extraction difficulties: long-term use of rigid feeding tube, feeding tube stay on the gastrointestinal wall and embedded in the gastrointestinal mucosa, resulting in feeding tube extraction difficulties. Other ways can be used, such as switching to a gastrostomy or jejunostomy. Too tight fixation of the jejunostomy tube with the intestinal wall or abdominal wall dirty layer suture ligation can also cause difficulty or resistance to the extraction of the feeding tube. In this case, the stoma tube can be cut so that the distal end is discharged from the intestine.  5, feeding tube displacement and prolapse: feeding tube is not firmly fixed or long-term placement, fixed catheter sutures loose and patient confusion, agitation or severe vomiting can lead to feeding tube prolapse. Once it occurs, not only can the EN not be carried out, but also in patients with stoma placement there is a possibility of peritonitis. Therefore, the catheter should be firmly fixed after placement, strengthen care and observation, and strictly prevent catheter dislodgement.  6. Misaspiration: Misaspiration caused by vomiting is often found in weak and comatose patients, and is likely to occur after vomiting or coughing in patients with esophageal reflux. The PH value of amino acid in enteral nutrition is low, and it is more irritating to bronchial mucosa after misaspiration, and once aspiration pneumonia occurs, it is more serious. Therefore, attention should be paid to the position of feeding tube and infusion rate, take the head 30° high, check the filling degree and residual amount in the stomach regularly, once the residual amount in the stomach exceeds 200ml, the input should be slowed down or stopped.  7. Stoma complications: The main complications of gastrostomy are bleeding from the stoma and overflowing gastric contents, occurrence of peritonitis, followed by non-healing of the wound and hernia next to the stoma. Complications of jejunostomy mainly include leakage of intestinal fluid from the stoma, prolapse of feeding tube, bleeding from the stoma, skin erosion and infection around the stoma, etc. If the stoma tube is not fixed tightly to the stomach/intestinal wall, it usually needs to be fixed properly by surgery again. Usually, attention should be paid to the disinfection and care of the skin of the abdominal wall next to the stoma. At the same time, attention should be paid to the presence of obstruction at the distal end of the digestive tract, and nutrient infusion should be reduced or discontinued.