Common complications

	Problem	Possible Causes	Action
1.	blocked tube prevention is the key flush, flush, flush	feeds too thick residue build up in the tube medicine too thick (some medicines can block the tube)	flush tube with warm water before & after feeds & medications ensure that blender prepared foods are in liquid form crush tablets to a fine powder and dissolve in a small amount of warm water do not give enteric coated and time releases medication through the tube if tube is blocked, may need to order for cotazyme and bicarb to unblock tube do not mix medications together

2.	irritation around tube site (stoma) sucralfate/desitin (3% in 25 grams) for "burned" skin cicatrin powder for wet and mucky skin proshield as a protective barrier if required	tube movement tension on the tube leaking from around the tube	ensure that tube is secured to decrease movement gently pull up on tube to ensure balloon/end of tube is up against the stomach wall be aware of marking of tube at abdomen (if it is not a low profile tube) assess patency of balloon, ensuring that water in balloon is intact for established tracts (more than 6 weeks old)
3.	migration of the tube	internal migration tube sliding further into the stomach external migration tube sliding out and sticking to the stomach wall intraperitoneal tube - out of the stomach - between stomach and skin	observe for signs of obstruction: vomiting, epigastric pain, increased leakage around the tube stop feeds immediately if migration to peritoneal cavity presumed call doctor if: pain, abdominal distension, nausea, vomiting, fever, swelling around the tube site and pain on feeding or flushing
4.	granulation tissue (hypergranultion tissue) – proud flesh around the tube site	body "walling off" from the tube body's reaction to the tube	may cauterize with silver nitrate sticks or treat with a short term low dose cortisone cream consult surgical nurse or physician ensure that tube is stable
5.	choking or coughing during feed	tube in the wrong place gastroesophageal reflux	elevate head for feedings notify physician if continues
6.	constipation	low stool volume lack of bulk in diet inadequate fluid intake medications	consult physician and/or dietician encourage activity increase water intake
7.	vomiting	too rapid infusion of feed excessive amount of feed	reduce rate of feed if vomiting continues, stop feed and reassess rate, type and consult a physician or dietician
8.	diarrhea	feed infusing too quickly feed too cold contamination of food or feeding equipment lack of bulk in diet high osmolaty of formula	reduce rate of feed infuse feed at room temperature check proper handling of equipment consult dietician for dietary changes or rate and concentration of formula
9.	psychosocial and emotional concerns	feelings of dependency, loss of control, loss of social aspect of eating, feelings of being different and change in body image	preoperative session for information exchange set goals adjust feeding schedule around activities and schooling plan feeding around meal times include the enterally fed child with family meals