Inadvertent intravenous administration of enteral diet

Needle catheter jejunostomy feedings were instituted in a 64-yr-old man on postoperative day 1 following subtotal gastrectomy for carcinoma of the antrum. Several days later, the enteral tube catheter was inadvertently connected to the patient's peripheral intravenous cannula which resulted in the intravenous administration of the enteral formula solution. The administration was stopped immediately when recognized, but 4 hr later the patient became febrile, hypotensive, and tachycardic. Cultures from the enteral solution demonstrated Streptococcal viridans and yeast; the patient's blood cultures similarly demonstrated S. viridans. Broad spectrum antibiotics, hemodynamic monitoring, and intravascular support with crystalloid solutions resulted in a favorable outcome. Prevention of the complication could be assured by adopting luer connectors for enteral feeding sets which cannot be connected to intravenous cannulas. Until these are available, the addition of methylene blue to the tube feeding formula or utilization of color coded distal connecting tubing may prevent accidental intravenous administration of tube feeding formulas. The potential for this complication must be recognized by those dealing with enteral feeding.