Should I let the hospital place a feeding tube in our loved one?

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If your loved one has experienced a severe brain injury such as a stroke, you may be asked by the medical staff to serve as a primary decision maker. Most decisions to be made are not overwhelming or controversial (for example, can we get your consent to place an intravenous line to deliver fluids?) But some decisions can be particularly difficult to make.

One difficult decision is whether or not a family should allow the medical staff to place a permanent feeding tube for their loved one.

If you are faced with this question, you may have some questions.

Why Does my Loved One Need a Feeding Tube?

When a person has suffered from severe damage to the brain, it can make it difficult to chew and swallow, and it can even impair his level of alertness. Often, stroke survivors are given IV fluids to maintain hydration in the first few days after a stroke. However, nutrition is very important, and IV fluids cannot provide all of the nutrition that your loved one needs.

If it takes your loved one longer than a few days to recover, the hospital staff may place a tube into the nose and all the way through to the stomach in order to deliver food. This is called a temporary feeding tube and it can be placed fairly easily at the bedside without any numbing medicine or incisions or stitches. This type of temporary feeding tube (also called a naso-gastric tube) is recommended for use for up to one month.

Another type of feeding tube, a permanent feeding tube, requires surgical placement and surgical removal. After a few weeks or a month, a more permanent form of feeding should be considered if your loved one is not able to eat food. 

Why Use a Permanent Feeding Tube?

You may ask why not to just keep using a temporary feeding tube.

There are several benefits to a temporary feeding tube, which are primarily based on the ease with which it can be placed and removed. But there are several disadvantages as well. When it comes to making a decision about placing a permanent feeding tube, there are several important reasons why it is not wise to wait too long.

*There is a high incidence of infections associated with the long-term use of temporary feeding tubes. Because of the way the temporary feeding tubes are positioned, food particles may enter into the lungs, causing aspiration pneumonia. Placing a long term feeding tube can reduce the high risk of aspiration pneumonia and other infections.

*A temporary feeding tube is not very secure, and may fall out easily, requiring replacement. While placement is not a huge procedure, frequently replacing a feeding tube can cause bleeding or abrasion on the way down the nose and the esophagus.

*Feeding tubes may be annoying or irritating and some stroke survivors who are not fully cooperative pull them out and may even refuse to have them replaced.

 

*If your loved one is not eating because he has severe brain damage, it might be impossible to determine if and when he will finally be able to eat on his own. This waiting period can be safer if a permanent feeding tube is placed to avoid infection and to maximize nutrition. This helps keep your loved one strong and swell nourished during the stroke recovery period.

A long term feeding tube can be removed, and that is the ultimate goal, but removal requires a procedure.

Caring for a Permanent Feeding Tube

Many families hesitate to allow a temporary feeding tube because it does, indeed, require some at home care. Once your loved one has the permanent feeding tube removed, he or she will not be able to tolerate all foods right away, and will need to adjust slowly to eating food by mouth.

However, rest assured that these issues are very familiar to your loved one's stroke care team and you will receive instructions and help to make sure that the care of the tube, as well as the recovery once the tube is removed, are safe.

Sources:

Hospital Readmissions of Stroke Patients with Percutaneous Endoscopic Gastrostomy Feeding Tubes.Wilmskoetter J, Simpson KN, Bonilha HS, J Stroke Cerebrovasc Dis. 2016 Oct;25(10):2535-42

Edited by Heidi Moawad MD

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