Guest Author - Diane Adams
Our family has been through the wringer in the past few weeks. First my mother died, and then her brother died five days later. Each family faced end-of-life decisions, but one family was more informed about medical procedures than the other. When facing these decisions, information is your best friend. In order to make informed decisions, you should know the pros and cons. In my opinion, the cons far outweigh the pros when considering the insertion of a feeding tube.
Two months before my mother’s death, she broke her hip and underwent a partial hip replacement. Following the surgery, she stopped eating and was drinking very little. As a result, her kidneys began to fail and hastened her death. My mother was 91 years old. Immediately following surgery, the nurses tried inserting an IV for fluids to try rehydrating her. Unfortunately, in my mother’s state of confusion, she pulled the IV from her arm. Because she could not understand the need for the IV, it was useless to try to insert another. When my mother entered the nursing home, my sister and I agreed that we did not want any extraordinary measures taken to prolong mother’s life.
Before my mother’s death, her brother, who was 88 years old, entered the hospital. His symptoms were nearly identical to my mother’s. He wasn’t eating, he was subsisting on coffee, and he was dehydrated. He was also experiencing difficulty breathing. He was rehydrated with IV fluids, but the doctor recommended to the family that my uncle be placed on a feeding tube. Without having knowledge of the consequences of a feeding tube, they agreed and my cousin signed the papers to have the procedure performed. Thankfully, my sister (a retired nurse) had called my aunt just in time to hear the news and she was able to explain the procedure to my aunt. If my uncle returned home following the procedure, my aunt would be unable to care for him which might or might not have required added expenses for his care. My aunt rescinded the order for the feeding tube.
When considering the use of a feeding tube, please be aware of the following drawbacks:
• Discomfort. Whether a feeding tube is a short-term or long-term solution, it is definitely not comfortable for the patient. For a short-term solution, the Nasogastric Tube is used. This method is exactly how it sounds. A tube is inserted in the nostril and run down the throat into the stomach. Long-term solutions offer two methods—a PEG tube or a Jejunostomy tube. A PEG tube is inserted in the patient’s side, just below the rib cage, through the abdominal wall, and directly into the stomach. The Jejunostomy tube is inserted just below the stomach, bypassing the stomach altogether, and moving straight into the jejunum (a portion of the intestine). None of these options sound comfortable to me.
• Leakage. This is a common problem associated with feeding tubes and generally occurs around the insertion point. Not only is leakage uncomfortable, it also permits bacteria to enter the insertion site and cause infection.
• Tension. When a patient moves around, tension is put on the feeding tube. Picture a dog on a leash straining to move too far from its owner. If the tension is too high, it can kill abdominal tissue.
• Clogging. The feeding tube can become easily clogged if not cleaned regularly. Cleaning the feeding tube is maintenance that cannot be ignored. The feeding tube should ideally be cleaned before and after each feeding. The standard of care for acute and long term care units is to change the entire tubing every 24 hours. The nutrition formulas are a great breeding ground for bacteria. Usually these feedings are administered by a pump set at a constant rate that constantly makes noise making it difficult to sleep. If the fluid is administered too fast it can cause regurgitation. If the head of the bed is not maintained the patient can aspirate the regurgitated fluid into the lungs which can lead to death. If you are the caregiver, are you prepared for the constraints on you that will be necessary to maintain your loved one’s feeding tube? In addition to cleaning the feeding tube, you need to be mindful of the type of liquids put in the feeding tube. Make sure you know everything there is to know before agreeing to do this for your loved one.
• Replacement and Cost. Please be sure to consider your financial situation before agreeing to a feeding-tube solution. Permanent feeding tubes need to be replaced at least every six months. You will need to allow for future hospital visits and surgeries in connection with feeding tube replacement.
• Time. The normal person spends 20-30 minutes eating a meal. This is not true for the patient with a feeding tube. The liquid must be inserted slowly to avoid complications and could take as long as an hour for a patient to ingest the fluid.
• Lack of Pleasure. For most of us, the best part of a meal is enjoying the food we are eating. Who doesn’t love a perfectly cooked steak, or a succulent lobster tail? My mouth fills with saliva just thinking about crème brulee. The patient with a feeding tube is deprived of tasting his or her food, which eliminates all enjoyment of eating.
Given the advanced years of both my mother and my uncle, a feeding tube was not a viable solution. If a 30-year-old required a feeding tube in order to survive, it might be a viable solution. However, keep in mind the quality of life in such circumstances. Making this decision requires thoughtful consideration.