Nasal Feeding Tubes Are Associated With Fewer Adverse Events Than Feeding Via Ostomy in Hospitalized Patients Receiving Enteral Nutrition.

Abstract

BACKGROUND Surgical feeding ostomies (e.g. gastrostomy) have have become required by many nursing facilities for all patients receiving enteral nutrition, whether for short- or long-term use. These policies lack supportive evidence. Comparisons of adverse event rates between surgical and natural orifice tubes are few, and lacking in the inpatient setting. Additionally, we hypothesize that adverse events related to feeding tubes are under-reported. We sought to quantify adverse events to test the relative safety of surgical feeding ostomies and natural orifice (e.g. nasogastric or orogastric) feeding tubes in hospitalized patients. METHODS A prospective observational cohort study of enterally fed inpatients using semiweekly focused physical exam, scripted survey, and chart review. RESULTS All tube-fed patients admitted to a large, urban, adacemic hospital received semi-weekly bedside evaluation and chart review over a 9 week period (n = 226 unique patients, mean 6.25 visits each, total 1118 observations). Demographics were comparable between 148 subjects with natural orifice and 113 subjects with surgical feeding tubes. A higher incidence of adverse events were observed with surgical tubes (3.34 versus 1.25 events per 100 subject days, p<0.001). Only 50% of all adverse events were documented in the medical record. More patients with surgical tubes were discharged to skilled nursing facilities (58% versus 24%). CONCLUSIONS Surgical feeding tubes are associated with significantly higher in-hospital adverse events rates when compared to natural orifice (nasal/oral) feeding tubes. Policies requiring surgical feeding ostomies should be reevaluated. FUNDING National Heart, Lung, and Blood Institute (Burgermaster-training grant T32 HL 7343-37).