What is the prevalence of feeding tube placement errors and what are the associated risk factors?

Enteral nutrition, given through feeding tubes to patients with intact gastrointestinal tracts who are unable to eat enough orally to sustain themselves, remains an important component of supportive care. Feeding by a soft, small-bore tube passed through the nose or mouth is a more cost-effective means of providing enteral nutrition than either percutaneously or surgically placed gastrostomy tubes or central venous catheters. However, tube feeding is not without problems. The prevalence of tube placement errors reported in the literature varies from 1.3% to 50% in adults. Transpyloric tubes are difficult to place initially and correct positioning is also difficult to maintain. All types of small-bore tubes dislocate easily, frequently with no outward sign that the dislocation has occurred. Risk factors found to be related to feeding tube misplacement on insertion in adults include altered level of consciousness, altered swallowing mechanisms, and upper airway intubation. Those related to spontaneous tube displacement include altered level of consciousness, upper airway intubation, coughing, tracheal suctioning, and restlessness.