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bbroke 10-10-2012 12:53 AM

please advise about Naso and gastric tube
Hi Community,
Please advise when it becomes necessary to insert feeding tube in dementia patient when the patient is very sensitive to foreign bodies and tends to remove them further also inform me pros and cons of all three type of feeding methods ie IV, naso and gastric tube (surgically fixed into stomach), in light of your experiences.

Luau 10-10-2012 08:29 AM

Re: please advise about Naso and gastric tube
When it becomes necessary to consider feeding tubes, you as caregiver need to the following, regardless of mode of feeding. First, you must assess the chances that the individual will regain the ability to self feed. In other words, you have to ask, is this temporary or is this permanent? Temporary is predicated that the patient is transiently incapacitated, and alternative feeding methods are implemented to allow time for recovery. If there is no expectation of recovery, you need to address the issues of quality of life and to what purpose. Among the three, intravenous feeding is the most aggressive is administered only as a temporary measure when the patient's GI tract is incapacitated. Prolonged intravenous feeding is not usually advised because the GI tract will degenerate without use. Feeding nutrients by nasalgastric route is the least invasive and appropriate for short term feeding of unconscious patients. For patients unable to self feed for extended times, then more aggressive measures are required. For dementia patients, please be very aware that these are extreme measures only to prolong physical life, but we all know that not being corporally dead is only part of being alive. I am very sorry you might be face with that decision. As usual, others much more knowledgable about this please correct me or add to this if I am off base.

jagsmu 10-10-2012 09:50 AM

Re: please advise about Naso and gastric tube
Hello broke, it sounds like you are trying to prepare for the next stage of Alzheimer. A feeding tube as luau stated is a very aggressive action to take, I am in complete agreement with the statement that I'd would do this is only as a temp. Measure then of course it must be done, but if this procedure is being done on someone in that latter stages of Alzheimer then one must consider who this procedure is benefiting, are you doing this in hopes that your loved one will get better, are you doing this because it was stated in your loved ones living will that they wanted this, all lot of these choices should have been made a long time ago before the person is at the point of needing one. It is up to us as the POA to carry out our loved ones wishes and remember this is about qualitity of life, theirs, many on this board have had to make this dessions, myselve included, I can only speak for myself, and I would never have let them give my mom a feeding tube, she had suffered enough, so my last gift to my mom was making the hardest dessions in my life,,but hear me, I do not for one moment regret it,,
Hugs to you and sending you strength

ninamarc 10-10-2012 10:19 AM

Re: please advise about Naso and gastric tube

I actually did a lot of research online about feeding tube for demented person.
Luau got a point, if it is temporary and can help reviving the patient, temp. feeding tube is OK. However, if the patient is in severe stage, at some point, feeding tube is not wanted by the person. Some research papers say that because the patient does not understand the tubes, she would take it off and endanger herself. As a popular practice here in North America, the feeding tubes and even the IVs or any tubes are not used for the demented patient with severe stage. In one or two cases, the family choose to keep the feeding tube if the elder still talks and doesn't want to die. Sometimes feeding tube can only make the person live for one more month so it may not be worth the suffering of the tubing.

Also, the feeding tube can cause infections on the wounds and often the patient needs to take lots of antibioitcs often. I know a disabled child who needs feeding tube all his life and he got infections a lot. For an older demented person, since she will get worse, such infections would be cruel to her. She would feel pain and so painkiller would be needed. The open wound is something one needs to take care of as long as there is a permanent tube. The stomach feeding tube is the one they use for such patients since they cannot swallow. The nasal tube can be removed easily by the person and it is not permanent. The food IV is only for a week or so with liquid and etc.

It is up to the family to decide this. If the elder has told you what she wants, go with her wish. If there is no such statement and you are the POA, you can decide for her whether she wants feeding tube or not.

It is not an easy choice. We took a while to decide not to have feeding tube for my late FIL. But he died without getting to that point yet. We did stop giving him IV and sending him to the hospital - the NH was doing the caregiving very well.


bbroke 10-10-2012 11:46 AM

Re: please advise about Naso and gastric tube
Dear Luau,jagsmu and ninamarc,
Million thanks for your kind advise and guidance. I am in the similar situation as jagsmu. The difficult part is that there in no living will and my mother is not in position to give it one now. Few days back when 500 ml of saline and 500 ml of amino were injected (in a week) to her she got this accumulated in her body and in lungs so the Dr stopped IV and prescribed lasix to get rid of accumulated water. Thus choice is not easy. Once again thanks all of you for your time.

Luau 10-10-2012 12:36 PM

Re: please advise about Naso and gastric tube
Dear BB,

I just noticed the thread you started not too long ago regarding your mother's UTI and her developing dementia-like symptoms. In that thread, it was not clearly established whether or not your mother is suffering from dementia, or whether her issues were more delirium-like associated with her physical ailments. Please note that all responses here is based on the assumption of dementia, and may not be fully appropriate for your mother. As a matter of priority, it seems the immediate task is to get her UTI under control. Then you can address her discomfort and her ability to pass urine. Her preference for sitting rather than lying supine suggest that she may be experiencing a certain degree of abdominal discomfort. I do not remember, but have you mentioned if they checked for kidney stones or other types of urinary blockage? The mental confusion and refusal to eat may also clear up if the abdominal issues, if they exist, are addressed. The means to introduce sustenance nutrients, whether by i.v., nasal gastric tube, or by stoma should be advised by her attendings depending on the time frame it may take to address these issues. Keep in mind that sustenance feeding by these means is for the purpose of sustaining life until such time a patient can regain ability to ingest food. In your mother's case, it may mean determination of what is ailing your mother and the time frame involved. Again, I am sorry you and your family are faced with these crisis decisions. It cannot be easy.

tinam7 10-10-2012 02:33 PM

Re: please advise about Naso and gastric tube
My heart goes out to you, Bb. There were differences in my family regarding this awful issue and since I was far away I had to accede to others. When I heard feeding tube, I shuddered. To me it was an extension of suffering even though I was always assured "he is not suffering." He had suffered so much for so long. His mind was gone. A sorrow that will never go away.

What it points to is that we must try our best to make our wishes known in a timely manner.

ninamarc 10-10-2012 02:51 PM

Re: please advise about Naso and gastric tube

You really need to talk to her doctor about the whole thing. Is she dying or if she needs hospice? Is there any other way to treat her or if they can still treat her? It is up to the doctor. You are not clear about what her diagnosis is so we cannot tell you what to do.
But do talk to her doctor in details and see if they think she can be saved or she is near death. Hospice can stop feeding tube, but aggressive treatments will allow these tubes to be tried on her while they figure out how to save her life.
In hospice given any disease, no treatments will be given and thus no feeding tubes.


Gabriel 10-10-2012 03:29 PM

Re: please advise about Naso and gastric tube
BB, Luau has given you excellent information about the different feeding tube options and advice on which to use and why. I can only add to that my thoughts on when.

I have thought long about this question and I had to ask myself... Is there hope for my Mom to return to quality of life... or would I only be extending the inevitable. I have been through this with my FIL after a sever stroke. There was no way for him to recover to quality of life and the family opted for comfort care only. I will eventually be there with my Mom due to her late state of Alzheimer's... and my family has already opted for Hospice care. I know when the time comes I will not be able to give her back quality of life because her condition is not treatable.

So you need to sit down with the doctors and discuss the prognosis. Is this temporary, and will she get better, or are you just extending the inevitable.

I am not sure about your country, but at least here in NC, even if the patient doesn't have a living will, the responsible party can make the necessary decision in cooperation with her physician. Again, your doctor's can give you guidance. If necessary talk to an elderly lawyer familiar with medical legalities.

This is a very difficult decision that you have to make with information and much thought. I wish for you the courage and strength to do what you need to do....

Love, deb

bbroke 10-11-2012 12:33 AM

Re: please advise about Naso and gastric tube
Hi all of you, Its very kind of you to share your experience and providing valuable suggestion. Tube feeding stage has not yet arrived but is not far away. Dr is here to advise us and we are proceeding accordingly but valuable information provided by all of you will sure guide me to take right decision. Dr says this is dementia and not in final stage. Thanks to all of you once again.

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