Detection of Complications Associated With Nasogastric Tube Feeding in Patients With Haemorrhagic Stroke in a Tertiary Hospital

Abstract

Background: Stroke poses the greatest disease burden in hospital admission among the non communicable diseases (NCD’s). In majority of cases haemorrhagic stroke is the common neurological problem. Many of the patients develop swallowing difficulty and require nasogastric feeding for maintenance of nutrition. But this feeding can be a double-edged sword as it can lead to many complications due to various factors including errors in the feeding method, dislodgement of the tube and many other causes. Our intention was to look into this neglected part of clinical practice as this is mostly handled by internists.

Objectives: To evaluate the complications of nasogastric tube feeding practice on haemorrhagic stroke patients.

Materials and methods: One hundred (100) adult patients aged between 18- 70 years with haemorrhagic strokeas enrolled in the study. Haemorrhagic stroke was diagnosed by the clinical presentation, neuroimaging (CT scan/ MRI). Patients requiring nasogastric tube feeding were included in the study. They were systematically examined for any complications related to use of nasogastric tube. Their caregivers were also thoroughly interviewed using a standard pre formed questionnaire regarding any complications as well. All data were be collected by using a preformed data sheet and results were presented in standard method after statistical analysis.

Results: Of the 100 patients studied, most common age group for stroke was 51-60 years (53%). Male to female ratio was 2.22:1. In this study population, 70% had intracerebral haemorrhage, 24% had Sub arachnoid haemorrhage and 6% had aneurysmal haemorrhage. The most common indication for NG feeding was difficulty in swallowing (39%). Other common indications were semi consciousness (26%), unconsciousness (22%), inability to maintain feed (10%). Around 71 % of the patients had complications from NG tube feeding. Out of them, 53% of the patients had nasal irritation where 63.15%was suffering from intracerebral haemorrhage, 31.57% and 5.26% were suffering from subarachnoid haemorrhagic and aneurysmal haemorrhage respectively. 40 % patients developed aspiration pneumonia, out of them 65.51%wasintracerebral haemorrhage, 31.03% was subarachnoid haemorrhagie ,3.44% was aneurysmal haemorrhage. 38% of the patients were developed diarrhea. Diarrhoea was reported by 66.66%, 29.62%, 3.70% in intracerebral haemorrhage, subarachnoid haemorrhagic and aneurysmal haemorrhage respectively. 53% had tube blockage, out of them intracerebral haemorrhage 71.05%, subarachnoid haemorrhage 23.68%, aneurysmal haemorrhage 2.63%. 43% of the patients had electrolyte imbalance, among them intracerebral haemorrhage 67.74% and subarachnoid haemorrhage 32.25%. Tube displacement was experienced by intracerebral haemorrhage 74.16%, subarachnoid haemorrhage 25.80% and 18% of the patients were malnourished.

Conclusion: NG tube feeding is an integral part of management of stroke patients with feeding difficulties. But often it is associated with various complications which can increase the morbidities in stroke patients.

J Dhaka Med Coll. 2022; 31(1) : 77-85