Manpreet S. Mundi, M.D., Home Parenteral and Enteral Nutrition, Mayo Clinic: I’m the medical director of the home enteral nutrition program and kind of oversee the entire program and what our program consists of is a combination of nurses, dietitians and physicians who have expertise in nutrition. Our job is to visit with the patients before they’re thinking about tube feeding and really talk to them about the ins and outs of what this entire process involves. This way they can make an informed decision and when they do so, they go ahead and move forward and get a tube placed. Typically these are placed in the abdomen. We then see them afterwards and then walk them through their first feeding. Once we’re pretty confident that, you know, they can handle this at home, then they continue the process at home. We then follow them afterwards at home. Usually they’ll get a call from us 24 to 48 hours after. Another touch point, a week after and then another touch point six weeks after. So a lot of our patients think this is overkill, but with this entire process, we’ve been able to catch a lot of complications and issues that can come up and really these would lead to complications or they would lead to frustration for the patient or even ER visits in the middle of the night. So with the program we’ve developed, we think we can prevent a lot of it and provide really high quality care.
The most common complications are things like infection. Others, at the site of insertion, you can get some granulation tissue developing. Some are rare complications but, you know, things like abdominal pain because of a buried bumper. The tubes have a bumper at the end of them and sometimes if it’s too tight, they can, you know, cause issues there, so those are the most common things. We also in nutrition work with the dietitians very closely to oversee and make sure that the formula is okay. So as an example, if we have a patient go out on a certain formula that does not contain fiber, they may have diarrhea or other problems so then we would call in and change the formula. So we’re working on all of these issues to make sure the patients do okay.
These tubes can be placed a number of ways, so at the Mayo Clinic, we have three different departments that deal with this. Our most common is our gastroenterologist. They will go in endoscopically so an endoscope through the mouth, illuminating either the stomach or sometimes we use the intestines as a source, so they’ll illuminate that and then go ahead and insert the tube that way. Interventional radiology also places a number of tubes for us and they use a CT scanner to kind of look at the location and then the other option is surgery. So our thoracic surgeons and a number of other surgeons also place these tubes but the essence of it is that there’s something that’s causing the patient not to be able to eat safely and so we’re essentially bypassing the mouth and the esophagus and going directly into either the stomach or the intestines and providing these feeds.
Some of the most most common reasons that I see are patients who’ve had a stroke. So these individuals no longer can protect their airway, so they’re at danger of if they were to eat, aspirate, and so the food would go into the lungs and cause a really bad pneumonia that can be very severe. Other common causes are throat cancers, mouth cancers. So in these cases again they’re not able to eat or they’ve had major surgery because of the cancer or radiation which is another common cause. So because of this, they may have severe pain with a little intake and can’t even drink water anymore, so that then so we then shift to providing feeds, you know, through the stomach until we can get them through the radiation.