Complications of Enteral Nutrition

ENTERAL nutrition is the preferred route for providing nutrition support when the gastrointestinal (GI) tract is functional. Compared with conventional central venous feeding, enteral feeding is associated with fewer serious complications, is more nutritionally complete, is more effective in maintaining or restoring host immune response, and takes advantage of normal physiologic and metabolic processes. In addition, delivery of nutrients by way of the GI tract allows maintenance of physical and immune-mediated barriers; decreases risk of sepsis; reduces the risk of cholestasis; and stimulates dozens of gut peptides, which affect far more than the GI tract.1-5 The cost of feeding tube placement, administration, equipment, and formula is also considerably less than parenteral nutrition. Most of the complications associated with enteral feeding are minor, but some can be quite serious. The incidence and severity of complications, however, can be reduced by assessment of the patient’s clinical status and nutritional needs, careful placement of the feeding tube, monitoring the feeding process, and proper selection and advancement of the formula. In this chapter, the more common complications of enteral nutrition are discussed along with guidelines for their prevention and treatment. Complications can be categorized in several ways, but we have grouped them under three main headings: (1) problems encountered during the placement of feeding tubes and delivery of enteral formulas (2) clinical and metabolic problems, and (3) nutritional problems.