In my recent research, I found an article on the use of feeding tubes in various, end of life or not so end of life, situations. The article was written by John Dunlap with the title “The Feeding Tube Dilemma: Key Questions”. Dunlap seemed supportive of temporary placement of feeding tubes post-surgery or when an individual has a treatable injury or illness. However, his sentiments about feeding tube use long-term brought into question whether the risk outweighed the benefits and what quality of life that individual would have.
Having a feeding tube placed is a surgical procedure which allows the food to go directly into the stomach, bypassing the mouth and esophagus. A more permanent reason one might have a feeding tube is if a person is unable to swallow due to illness, disease, or the lack of mental capacity, whether from a stroke, mental illness or developmental abnormality. Some of these individuals are mobile, while others spend their lives in bed.
Dunlap discussed the discomforts of feeding tubes and whether the complications outweigh the benefits. In my experience, the biggest reason a patient with a feeding tube is brought to the hospital is because they aspirated on tube feed or the site where the tube was placed has become infected, leading to sepsis, a potentially life threatening infection. If a patient has a feeding tube and strict precautions are not followed, individuals will acquire aspiration induced pneumonia leading to a lengthy hospital stay. Often times, as Dunlap mentioned in his article, patients with feeding tube nutrition will have chronic diarrhea. The hospital will treat the symptoms and send them home only to have them return weeks or months later with the same diagnosis.
On several occasions, I have had patients who are physically and/or mentally challenged, bedridden and live in group homes. Most group homes do not have the tools or training to handle the medical demands of a resident with complex health needs, especially when they have a feeding tube. This brings about the question of whether these individuals, who are absent of family and any financial means, should be left in facilities that are unable to care for them. However, if the feeding tubes were not placed, these individuals would die of malnutrition and starvation. If these individuals are unable to speak for themselves, who can advocate for them and make the decision on whether they will live with a feeding tube or die without one?
https://cbhd.org/content/feeding-tube-dilemma-key-questions
This comment has been removed by the author.
ReplyDeleteHey Elizabeth, are there any alternatives to feeding tubes? Is careful mouth feeding an option?
DeleteGreat post!
So typically individuals who have feeding tubes are unable to swallow on their own or aren't able to choose which pathway the food goes down, the esophagus or the windpipe. There are some individuals who are considered "at-risk" of aspirating, but with the proper precautions like sitting upright when eating or drinking, eating pureed foods or using liquid thickeners, can take in the needed nutrients. In the first scenario, I would say we currently do not have an alternative option other than the feeding tube, even though they offer a direct pathway into the body for infection and due the the slow infusion of food over long periods of time leaves them at high risk for aspiration.
ReplyDelete