CLINICAL RESEARCH STUDY

Nasal Feeding Tubes Are Associated with Fewer

Adverse Events than Feeding via Ostomy in
Hospitalized Patients Receiving Enteral Nutrition
Chip Alex Bowman, MD, MPH,a Elizabeth Hutchins, MD,b Marissa Burgermaster, PhD,c Vivek Sant, MD,d
David S. Seres, MD, ScMe
a
Department of Medicine, Mount Sinai Hospital, New York, NY; bDepartment of Medicine, Harbor UCLA Medical Center, Torrance, Calif;
c
Department of Nutritional Sciences, Dell Medical School, University of Texas at Austin, Austin; dDepartment of Surgery, NYU School of Medi-
cine, New York, NY; eInstitute of Human Nutrition and Department of Medicine, Columbia Univeristy Irving Medical Center, New York, NY.

ABSTRACT

BACKGROUND: Surgical feeding ostomies (eg, gastrostomy) have become required by many nursing facili-
ties for all patients receiving enteral nutrition, whether for short- or long-term use. These policies lack sup-
portive evidence. Comparisons of adverse event rates between surgical and natural orifice tubes are few
and lacking in the inpatient setting. Additionally, we hypothesize that adverse events related to feeding
tubes are underreported. We sought to quantify adverse events to test the relative safety of surgical feeding
ostomies and natural orifice (eg. nasogastric or orogastric) feeding tubes in hospitalized patients.
METHODS: This was a prospective observational cohort study of enterally fed inpatients using semiweekly
focused physical examination, scripted survey, and chart review.
RESULTS: All tube-fed patients admitted to a large, urban, academic hospital received semiweekly bedside
evaluation and chart review over a 9-week period (n = 226 unique patients, mean 6.25 visits each, total 1118
observations). Demographics were comparable between 148 subjects with natural orifice and 113 subjects
with surgical feeding tubes. A higher incidence of adverse events was observed with surgical tubes (3.34 vs
1.25 events per 100 subject days, P < .001). Only 50% of all adverse events were documented in the medical
record. More patients with surgical tubes were discharged to skilled nursing facilities (58% vs 24%).
CONCLUSIONS: Surgical feeding tubes are associated with significantly higher in-hospital adverse event
rates when compared with natural orifice (nasal or oral) feeding tubes. Policies requiring surgical feeding
ostomies should be reevaluated.
Ó 2021 Elsevier Inc. All rights reserved.
The American Journal of Medicine (2022) 135:97−102

KEYWORDS: Enteral nutrition; Gastrostomy; Nasogastric feeding tube; Tube feeding complications

INTRODUCTION nutrition administered via the different available routes.

Although enteral nutrition is a widely practiced method for
providing nourishment to hospitalized patients, there is a
dearth of research comparing complications of enteral
Funding: National Heart, Lung, and Blood Institute (Burgermaster—
training grant T32 HL 734337).
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing
this manuscript.
Requests for reprints should be addressed to David S. Seres, MD, ScM,
PNS, Division of Preventive Medicine and Nutrition, Department of Medi-
cine, Columbia University Medical Center P&S 9-501, 630 West 168th St,
New York, NY, 10032.
E-mail address: dss2135@cumc.columbia.edu
These routes can be broadly characterized as natural orifice
feeding tubes (eg, nasogastric and orogastric) and surgical
feeding enterostomies (eg, percutaneous endoscopic gastro-
stomy or jejunostomy, surgical feeding ostomy, interven-
tional radiology placed feeding ostomy). Percutaneous
endoscopic gastrostomy was introduced in 1980 and is now
estimated to account for approximately 250,000 annual pro-
cedures in the United States.1-4 In practice, surgical feeding
ostomies are generally chosen when long-term enteral nutri-
tion is required.
Results of comparisons between the safety of surgical
feeding ostomies and natural orifice feeding tube for long-

0002-9343/© 2021 Elsevier Inc. All rights reserved.

https://doi.org/10.1016/j.amjmed.2021.08.020
98 The American Journal of Medicine, Vol 135, No 1, January 2022

term use are mixed. Reported complication rates vary widely, documentation in the electronic medical record compared
from 16% to 70%.5 On average, reported rates of overall com- with a bedside assessment by a study investigator.
plications throughout the world appear to be around 17% with
similar rates of 21%-25% reported by studies specifically con-
ducted in the United States.6-8 A Cochrane review published METHODS
in 2015 reported results of a meta-analysis of 9 randomized Subjects were hospitalized in the Milstein Hospital of NY-
controlled trials and found long-term use of surgical feeding Presbyterian Hospital system at Columbia University Irving
ostomies was associated with nomi- Medical Center, a large urban ter-
nally less intervention failure than CLINICAL SIGNIFICANCE tiary care adult university hospital
natural orifice feeding tubes.9 How- located in New York City. All
ever, no significant difference was
Recommending surgical feeding osto- patients receiving tube feeding were
found in complication rates between mies (eg, percutaneous endoscopic visited twice weekly by one of the
surgical feeding ostomies and natural gastrostomy) for longer-term use lacks investigators, for the 9-week period
orifice feeding tube, and many stud- compelling data supporting superiority from December 28, 2015, through
ies reported conflicting results. Nev- over nasogastric feeding tubes. February 24, 2016. Subjects were
ertheless, surgical feeding ostomies
Nursing homes refuse nasal tubes, even identified by filtering electronic
have been associated with higher
for short-term use, driving unnecessary health records for currently admit-
risks for more severe complications, ted patients with orders for any type
or futile gastrostomies in sicker
including bleeding, perforation sec- of enteral nutrition. This list was
ondary to endoscopy, adjacent organ patients (eg, simultaneous placement repopulated semiweekly. Subjects
injury, tube dislodgement leading to with tracheostomy). were excluded if they were no lon-
peritonitis, cellulitis, buried bumper
Gastrostomies are associated with ger receiving enteral nutrition at the
syndrome, as well as colocutaneous nearly twice the incidence of adverse time of observation (ie, order dis-
fistula and local skin injury second- events compared with nasal or oral continued), if they had already had
ary to leakage.10 Therefore, despite feeding tubes in hospitalized patients. an surgical feeding ostomy placed
similar complication rates, surgical
Policies requiring placement of surgical on a prior admission, or if the sub-
feeding ostomies may in fact be asso- feeding ostomies require reevaluation. ject could not be seen during the
ciated with more severe morbidity. hours of 9 am-5 pm (eg, subject
Despite this evidence, the deci- gone for a test or procedure). Sub-
sion to place surgical feeding ostomies over natural orifice jects or family members were told
feeding tubes in hospitalized patients can be influenced by about the nature of the study and asked verbally for their
nonclinical factors such as disposition planning. A recent willingness to participate. The study protocol was approved
study found that 82% of New York City nursing homes or by the Columbia University Medical Center Institutional
skilled nursing facilities require surgical feeding ostomies Review Board (protocol number AAAM2257).
and refuse patients with natural orifice feeding tubes, com- Subjects (or a family member, if the subject was unable)
pared to national average of 38%.11 New York City nursing were asked a series of scripted questions regarding their
homes require surgical feeding ostomies even when the tube-feeding experience. Scripts were designed by consen-
anticipated duration of tube feeding is short (ie, 1-2 weeks). sus of the research team (Appendices A and B, available
This exposes patients to the risks of the procedure with online). At the initial visit, subjects or family were asked if
arguably no compelling data to support the more invasive they were currently experiencing adverse events with their
surgical feeding ostomies.9 Additionally, placement of feeding tube. At subsequent visits, subjects or family were
feeding gastrostomy is frequently performed at the same asked if they had experienced adverse events since the last
time as a tracheostomy, often in critically ill patients.12 encounter. In the case of non-English-speaking subjects or
This may reflect the shift to a less selective population with families, phone interpreter services were used (Pacific Inter-
greater 30-day mortality than the general hospital popula- preters, Inc.). For the first 5 weeks, if a nurse or family mem-
tion. ber was present, they were asked to answer these questions
We conducted a 2-month prospective observational on behalf of nonverbal subjects. In the last 4 weeks, the
study in an urban academic medical center to better under- nurse was asked the scripted questions on behalf of the sub-
stand adverse event rates and discharge disposition among ject for every subject encounter in which the subject was
hospitalized patients receiving enteral nutrition. Specifi- unable to answer. A focused physical examination was per-
cally, we assessed and compared rates and types of adverse formed at each encounter; subjects were examined for
events associated with natural orifice feeding tubes versus mechanical and infectious complications (eg, tenderness,
surgical feeding ostomies, the mortality rates of subjects septal erosion, ulcer, and epistaxis for natural orifice feeding
receiving tube feeds, and the discharge disposition of those tubes; tenderness, erythema, blood, leakage, matted sutures,
subjects continuing to receive enteral feeds at time of dis- fluctuance, and crepitus for surgical feeding ostomies).
charge. To better understand the adverse event rates associ- At the conclusion of in-person data collection, chart
ated with enteral feeds, we also assessed the rate of review was performed to obtain demographic information
Bowman et al Fewer Adverse Events with Nasal Feeding Tubes than Gastrostomies 99

(NOFT vs SFO)*

IR = interventional radiology; NGT = nasogastric tube; NOFT = natural orifice feeding tube; OGT: orogastric tube; PEG: Percutaneous endoscopic gastrostomy; PEJ: percutaneous endoscopic jejunostomy; S= sur-
including age, gender, date of admission, location of obser-
vation (ie, intensive care unit [ICU] vs non-ICU), as well as

P Value
date of insertion, method of insertion (ie, endoscopic, surgi-

<.001
<.01
.67

.39
cal, or via interventional radiology), discharge destination,
nutritional status at discharge (ie, surgical feeding ostomy,
natural orifice feeding tubes, oral diet), and date of in-hospi-

t-test
Value

-0.42

0.85
tal mortality, if applicable. Presence or absence in the chart
of reference to adverse tube-feeding- or ostomy-related
events discovered during the visit was also collected.

x2 Value
To examine adverse event rates, subjects were stratified

283.1
7.08
by feeding tube type, and total adverse events were divided
by total days under observation divided by 100 to determine

1118 (100%)
incidence of adverse events for each tube type per 100 hos-

51.1% (571)
58.1% (650)
261 (100%)
pital days. Disposition type and mortality rates were deter-
mined by the type of feeds subjects were receiving at the

Total

10.0

61.7
15.2
time data collection ended, thus classifying subjects who

35
crossed over from natural orifice feeding tubes to surgical
feeding ostomies to be considered in the surgical feeding

66.7% (26)
20.5% (8)
12 (4.6%)

39 (3.5%)
ostomies group. Data were analyzed using SPSS v.25.13 To

PEJ - S
assess differences in demographics and adverse events we

54.5
15.4
8.6
used 2-sided independent t-tests for continuous variables

1
and x2 tests for independence for dichotomous variables.

100.0% (5)
0.0% (0)
1 (0.4%)

5 (0.4%)
PEJ - IR
RESULTS

15

56
0

0
The demographic characteristics of the study cohort are
summarized in Table 1. For the purposes of our analysis,

95.0% (19)
20 (1.8%)

10.0% (2)
“surgical feeding ostomy” includes endoscopically placed
4 (1.5%)
PEG - S
SFO

gastrostomy (percutaneous endoscopic gastrostomy) as

12.2

59.3
6.9
well as surgically and interventional radiology-placed gas-
3

trostomy and jejunostomy, while natural orifice feeding

tubes includes orogastric and nasogastric tubes. No subjects
65.7% (23)
12 (4.6%)

35 (3.1%)

0.0% (0)

had nasojejunal or orojejunal tubes placed during the study

PEG - IR

period. Over the course of 9 weeks, 226 unique patients

64.5
14.7
7.7

were seen an average of 6.25 times each for a total of 1118

7

unique observations. In total, there were 116 nasogastric *P values and test statistics reported for NOFT versus SFO subtotal values.
59.9% (209)
349 (31.2%)

tube, 32 orogastric tubes, and 113 subjects with surgical

23.2% (81)
84 (32.2%)

feeding ostomies (84 percutaneous endoscopic gastrostomy,

12 interventional radiology-placed gastrostomies, 4 surgi-
12.1

61.9
16.3
PEG
Table 1 Descriptive Characteristics by Feeding Tube Type

24

cally placed gastrostomies, 1 interventional radiology-

gical; SFO = surgical feeding ostomy; STD = standard deviation.

placed percutaneous endoscopic feeding gastrojejunostomy,

98.9% (88)
51.7% (46)
32 (12.3%)

and 12 surgically placed feeding gastrojejunostomies). Of

89 (8.0%)

the 113 subjects with surgical feeding ostomies, 35 had

60.0
OGT

crossed over from natural orifice feeding tubes during the

5.7
—

16

study and were observed with both feeding tube types. The
NOFT

2 subgroups of patients with natural orifice feeding tubes

67.5% (392)
55.4% (322)
116 (44.4%)

581 (52%)

and surgical feeding ostomies were comparable in age

(mean 62.0 vs 61.2, P = .39) but not sex (55% male with
10.0

62.4
14.6
NGT

natural orifice feeding tubes vs 63% male with surgical

—

feeding ostomies, P < .01). ICU admission was used as a

surrogate for severity of illness for the groups. For subjects
Feeding mechanism

with surgical feeding ostomies, 20.3% of observations

Mean days under

made in the ICU compared with 71.6% for those with natu-
observation
Observations

ral orifice feeding tubes (P < .001).

Crossovers

Mean Age

The most common adverse events reported for patients

Patients

Age STD
Male, %
ICU, %

with natural orifice feeding tubes were nasal discomfort,

tube feeding intolerance, and skin irritation. For surgical
100 The American Journal of Medicine, Vol 135, No 1, January 2022

Table 2 Adverse Events by Feeding Tube Type (Adverse Events, home, 21% discharged to an acute or subacute rehabilita-
Based on Bedside Observation and Interview, per 100 Observed tion facility, and 34% discharged to a skilled nursing facil-
Hospital Days)* ity. Disposition data stratified for patients with natural
NOFT SFO t-test Value P Value orifice feeding tubes demonstrated 30% mortality, 19% dis-
Local pain 0.25 0.4 -0.71 .48 charged home, 27% discharged to a rehabilitation facility,
Bleed 0.08 0.09 -0.152 .87 and 24% to a skilled nursing facility. In contrast, patients
Dislodgement 0.02 0.26 -1.96 .051 with surgical feeding ostomies had 10% mortality, 24% dis-
Clog 0.02 0.25 -3.2 .001 charged home, 8% discharged to a rehabilitation facility,
Leak 0.05 0.36 -0.259 .01 and 58% to a skilled nursing facility. Overall, mortality was
Skin (superficial) 0.17 0.41 -0.167 .096 statistically more likely in subjects with natural orifice feed-
Soft tissue infection 0 0.13 -1.71 .087 ing tubes (P = .001, x2 9.8049). However, this association
Epistaxis 0.02 0 1.11 .267 was not present when controlling for ICU status (P = .684,
Nasal discomfort 0.29 0 2.89 .004 x2 0.166). Of the 45 patients with natural orifice feeding
Other (buried bumper, 0 0.03 -0.157 .117
tubes who died, 5 were located on the medical floor and 40
pneumoperitoneum)
were in the ICU. Of the 6 patients with surgical feeding
Tube feedingy intolerance 0.36 0.88 -2.35 .019
Total adverse events 1.25 3.34 -3.73 <.001 ostomies who died, 3 were in the medical floor and 3 were
located in the ICU. Of note, 5 subjects died in the hospital
NOFT = natural orifice feeding tube (eg, nasogastric, orogastric, naso-
jejunal tube); SFO = surgical feeding ostomy (eg, percutaneous endo-
after crossing over from natural orifice feeding tubes to sur-
scopic gastrostomy/jejunostomy, surgical feeding ostomy, gical feeding ostomy. Six patients with natural orifice feed-
interventional radiology placed feeding ostomy). ing tubes and 1 patient with surgical feeding ostomy were
*Values of adverse events included were those that were reported transferred to hospice.
based on interviews and not what was recorded in the medical record.
yTube feeding intolerance includes vomiting, diarrhea, and
distension.
DISCUSSION
In this prospective observational study, we found that surgi-
feeding ostomy patients, the most commonly reported cal feeding ostomies were associated with significantly
adverse events were tube feeding intolerance, skin irrita- higher rates of adverse events, and more serious adverse
tion, and local pain. The adverse event rates for each feed- events, than natural orifice feeding tubes. Rates for clogs,
ing tube type are detailed in Table 2. Values of adverse leaks, and tube-feeding intolerance were significantly
events included were those that were reported based on higher in patients with surgical feeding ostomies. Tube-
interviews and not what was recorded in the medical record feeding intolerance includes distension, diarrhea, and vom-
and are reported as adverse event per 100 hospital days. iting. We found nonstatistically significant associations
Overall, a significantly higher incidence of adverse events between surgical feeding ostomies with more dangerous
per 100 subject days was observed in subjects with surgical adverse events such as cellulitis and pneumoperitoneum or
feeding ostomies than natural orifice feeding tubes (3.34 vs buried bumper syndrome (reported here as “other”). Low
1.25, P < .001). Similarly, surgical feeding ostomies had incidence is likely the reason for lack of statistical signifi-
significantly higher incidence of clogs (0.02 vs 0.25, P < cance here because the data does follow previously estab-
.001), leaks (0.05 vs 0.36, P < .01), and tube-feeding intol- lished trends. Additionally, surgical feeding ostomies did
erance (0.36 vs 0.88, P = .019). Patients with natural orifice have higher rates of clogs, leaks, and tube-feeding intoler-
feeding tubes had a higher rate of nasal discomfort (0.29 vs ance. This is particularly noteworthy as dislodgments and
0, P = .004). leaks are likely to be more harmful in the case of surgical
The comparison of electronic health record and inter- feeding ostomy as the integrity of the abdominal wall may
view-documented adverse events demonstrated that 48.6% be compromised. Meanwhile, natural orifice feeding tube
of observed natural orifice feeding tube adverse events adverse events were less severe and were limited to nasal
were documented in daily physician progress notes com- discomfort.
pared with 50.8% for surgical feeding ostomies. This Regarding specific adverse events, no pneumonias
equated to an overall rate of documentation of 50% of all developed in either group during the study period; this is
adverse events. A total of 50 adverse events were recorded consistent with previous data that demonstrates risk of aspi-
in the electronic health record for patients with natural ori- ration and pneumonia are similar between surgical feeding
fice feeding tube compared to 72 for patients with surgical ostomies and natural orifice feeding tubes.9 Another spe-
feeding ostomy. Not documented were 55 and 74 adverse cific adverse event of interest was pain. In the present study,
events, respectively. There was not a statistically significant surgical feeding ostomies had nonstatistically significant
difference in documentation between the 2 groups as higher rates of local pain and discomfort than natural orifice
assessed by x2 (P = .50, x2 0.461). feeding tubes. This argues against the common perception
Upon conclusion of the study 13 patients remained inpa- that natural orifice feeding tubes cause more discomfort
tient, all of whom had natural orifice feeding tubes. For the when compared to surgical feeding ostomies. This percep-
remainder of the patients, 24% died, 20% were discharged tion is a major deterrent for use of natural orifice feeding
Bowman et al Fewer Adverse Events with Nasal Feeding Tubes than Gastrostomies
tubes in long-term feeding settings.11 Lower adverse event
rates for patients with natural orifice feeding tubes could be
influenced by various factors. Notably, since most subjects
with natural orifice feeding tubes were seen in ICU, many
were nonresponsive at the time of the examination and,
therefore, could not report on their experience of comfort
with natural orifice feeding tubes. Patient reporting was
considered the gold standard for adverse event reporting in
this study, in contrast to documentation in the electronic
health record. Moreover, several of the observations for
subjects with surgical feeding ostomies took place immedi-
ately after surgical feeding ostomy placement in which
postoperative tenderness is expected and would be expected
to wane overtime.
Of those who received surgical feeding ostomies com-
pared with natural orifice feeding tubes, more were male.
This is surprising because there was not a statistically sig-
nificant difference between men and women in the ICU set-
ting (P = .12, x2 2.44). Furthermore, there was no
difference in total adverse event rates between men and
women (P = .78, x2 0.495). This may suggest an uncon-
scious bias in who is deemed eligible to benefit from a sur-
gical feeding ostomy versus natural orifice feeding tube. Of
note, although there was a significant mortality difference
between the 2 groups, this difference was not present when
controlled for ICU status. This suggests that mortality may
be associated with severity of illness, rather than feeding
tube type.
Very few subjects were discharged while still receiving
feeds via natural orifice feeding tubes, and significantly
more subjects were discharged with feeding via surgical
feeding ostomies. Subjects with surgical feeding ostomies
were most likely to go to skilled nursing facilities. It is not
clear whether the initial choice of surgical feeding ostomy
was preferred over natural orifice feeding tube because the
treating team anticipated that the subject would need skilled
nursing facility at discharge or whether surgical feeding
ostomy was a marker of need for post-acute nursing care.
This raises important questions about whether skilled nurs-
ing facility policy influences medical decision-making.
Substantially more adverse events were observed during
our study protocol than were charted in physician progress
notes. This trend was true for both surgical feeding osto-
mies and natural orifice feeding tubes without a significant
difference in reporting rates between the 2 groups. The
dearth of documentation of adverse events may signify an
underappreciation by practitioners of the risks of enteral
feeding. Because surgical feeding ostomies are associated
with more serious adverse events, lack of documentation
for adverse surgical feeding ostomy-related events may
have more important clinical implications than for natural
orifice feeding tubes. This underappreciation of the adverse
effects of surgical feeding ostomies by physicians may fur-
ther compound biases favoring this intervention over natu-
ral orifice feeding tubes.
Our study has several important limitations. It was con-
ducted at a single institution and from a convenience
101
sample, which limits generalizability. Furthermore, the
study only included hospitalized subjects, which likely
makes for a sicker sample of subjects than the overall popu-
lation of patients receiving tube feeds and precludes its gen-
eralizability to outpatient use of these feeding methods. The
difference in distribution of patients, where patients with
natural orifice feeding tubes tend to be in ICUs, and patients
with surgical feeding ostomies tend to be out of ICU, may
be a source of bias. Furthermore, indication for enteral feed-
ing was not documented. This information could shed light
on inappropriate use of surgical feeding ostomies, though
the outcomes documented here of adverse events and dis-
charge planning would likely be unaffected by inclusion of
this data. Finally, discharged subjects were not followed for
mortality, and so the current mortality rates are reflective
only of survival during hospitalization.
Future research should examine those receiving tube
feeds in the post-acute setting to better assess the full expe-
rience of natural orifice feeding tubes and surgical feeding
ostomies and should include an examination of the indica-
tions for enteral feeds. However, this study provides a large
sample of patients being discharged from acute care to New
York City nursing homes. Our findings may help inform
decisions surrounding enteral nutrition in similar patients.
Future research should also assess the long-term outcomes
of these subjects, including rehospitalization rates and
long-term mortality rates.
CONCLUSION
In this study, surgical feeding ostomy was associated with
more frequent and more serious adverse events than natural
orifice feeding tube, while adverse event documentation
rates were significantly low across both groups. These
results suggest that surgical feeding ostomies may be a
higher-risk intervention than natural orifice feeding tubes in
the hospital setting. Clinicians and administrators should
consider these results in patient care and discharge and
admission policy decisions. Nursing home policies that
require surgical feeding ostomies may place patients at
undue risk for serious and under documented compilations,
especially when the prognosis for recovery of full oral nour-
ishment is short term or indeterminate.9 Future research
should examine strategies to compare the safety of natural
orifice feeding tubes and surgical feeding ostomies in a
more controlled manner including surgical feeding ostomy
reversal rates and to further incorporate outpatient experien-
ces. In the absence of strong evidence for superiority of sur-
gical feeding ostomies, skilled nursing facilities should
place more emphasis on patient prognosis, patient auton-
omy, and risk-to-benefit in their admission policies. The
inability to accept a less invasive and noninferior feeding
method is particularly critical when nutritional support is
required for short or indeterminate periods of time, if a nat-
ural orifice feeding tube is well tolerated, and when pre-
ferred by the patient.
102
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SUPPLEMENTARY DATA
Supplementary data to this article can be found online at
https://doi.org/10.1016/j.amjmed.2021.08.020.
Bowman et al Fewer Adverse Events with Nasal Feeding Tubes than Gastrostomies
APPENDIX A
This is the script used when visiting subjects (as well as
their families and nurses) with nasogastric tube. Note, on
the initial visit, all questions were framed as “are you cur-
rently experiencing,” rather than “since our last visit have
you experienced?”
1. Since our last visit, have you experienced discomfort in
your nose or throat?
2. Since our last visit, have you experienced any bleeding
at the site of your tube?
3. Since our last visit, has the tube been dislodged (fallen
out)?
4. Since our last visit, has the tube been clogged?
5. Since our last visit, have you vomited?
6. Since our last visit have you had diarrhea, loose stools,
other changes in bowel movements?
7. Since our last visit, have you had residual tube feeds?
8. Since our last visit, have you experienced any other
complications from your feeding tube?
APPENDIX B
This is the script used when visiting subjects (as well as
their families and nurses) with gastrostomy. Note, on the
102.e1
initial visit, all questions were framed as “are you currently
experiencing,” rather than “since our last visit have you
experienced?”
1. Since our last visit, have you had any pain/tenderness at
the since of your [feeding ostomy]?
2. Since our last visit, have you had any changes in the
skin or bleeding around your [feeding ostomy]?
3. Since our last visit, has the tube been clogged?
4. Since our last visit, has there been any leakage around
your [feeding ostomy] site?
5. Since our last visit, has the tube been dislodged (fallen
out)?
6. Since our last visit has the tube broke?
7. Since our last visit, have you vomited?
8. Since our last visit have you had diarrhea, loose stools,
other changes in bowel movements?
9. Since our last visit, have you had residual tube feeds?
10. Since our last visit, have you experienced any other
complications from your feeding tube?