4.1 Identify potential risks associated with extended feeding

This guide will help you answer 4.1 Identify potential risks associated with extended feeding.

Extended feeding, often through tube feeding or other specialised methods, is sometimes necessary for people who cannot eat or drink safely. While this procedure provides essential nutrition, it can introduce a number of risks. Recognising these risks means you can work with the person, their family, and the wider care team to minimise them and promote safety and wellbeing.

In this guide, we will cover some of the most common risks that come with extended feeding. Each person may face some or all of these, depending on their health, environment, and feeding method. Remember that every person may react differently.

Infection

Bacteria can enter the body in several ways during extended feeding and cause infection. This risk includes:

• Site infections: The area around a feeding tube can become red, swollen, painful, or produce discharge.
• Internal infections: If bacteria travel down the tube, infections can develop inside the stomach or intestines.
• Sepsis: In severe cases, bacteria can spread through the bloodstream, causing a life-threatening reaction.

Infection risk is higher if equipment is not washed properly, hands are not clean, or the tube is touched more often than needed.

Blockages and Displacement

Tubes used for feeding can become blocked or move out of place. Risks include:

• Food, medication, or formula residues causing tube blockages, stopping or slowing feeds.
• Tube displacement, where the tube slips out of the correct position, poses health dangers, such as feeding into the lungs.
• Accidental removal, especially in people who are confused or agitated.

A blocked or displaced tube can lead to missed feeds, discomfort, or serious medical emergencies.

Aspiration

Aspiration means food, liquid, or stomach contents enter the lungs instead of the stomach. This risk is especially high if:

• The person is lying flat during feeding.
• The tube moves into the lungs.
• There are swallowing difficulties or coughing.

Aspiration can cause coughing, chest infections, pneumonia, and breathing difficulties. This is a medical emergency in some cases.

Gastrointestinal Problems

The digestive system may react in several ways to extended feeding, including:

• Nausea or vomiting
• Diarrhoea
• Constipation
• Bloating or abdominal pain

These reactions can be due to feed intolerance, speed of feeding, formula changes, or infection.

Skin Problems

The skin around the tube site is sensitive and prone to damage. Potential issues include:

• Redness, swelling, or sores from constant moisture or friction.
• Pressure ulcers if feeds are given while lying in one position for too long.
• Leaking of stomach contents, causing irritation and breakdown of the skin.

Emotional and Psychological Impact

Living with extended feeding can bring risks to emotional wellbeing:

• The person may feel isolated, embarrassed, frustrated, or lose interest in socialising.
• Anxiety or depression may develop, especially if feeding reduces independence.
• Stress for family or partners who provide care and support.

Emotional risks can sometimes lead to the person refusing feeds, increasing the chance of malnutrition.

Nutritional Risks

While extended feeding aims to supply nutrition, risks still exist:

• Incorrect formula or rates may result in underfeeding (malnutrition) or overfeeding (weight gain, fluid overload).
• Missing key vitamins or minerals, particularly if the formula is not chosen carefully.
• Dehydration if additional water is not given when needed.

Regular monitoring and reviews by dietitians are important to avoid these problems.

Mechanical Complications

Problems can occur with feeding equipment or technique, such as:

• Broken, leaking, or disconnected feeding tubes or pumps.
• Air entering the tube, causing discomfort or stomach pain.
• Incorrect cleaning, leading to contamination or blockages.

Poorly-maintained equipment can increase risks for the person receiving the feed.

Choking

Although tubes are designed to avoid choking, small incidents can still happen if:

• Equipment is incorrectly attached or managed.
• The person tries to eat or drink by mouth when it is not safe.
• Secretions or vomit are not cleared promptly.

Choking can lead to panic, distress, and serious medical emergencies.

Financial and Practical Concerns

There are often risks that relate to finances and daily living:

• The cost of special feeds, equipment, or travel to clinics.
• Disruption to work or home life.
• The need for ongoing carer support or community nursing.

These factors can cause stress or difficulty in managing daily routines.

Legal and Safeguarding Risks

If extended feeding is carried out incorrectly, the person’s legal and human rights may be at risk:

• Feeding against someone’s wishes or without proper consent, breaching their rights.
• Failure to follow care plans or professional advice, leading to harm, can carry legal consequences.
• If safeguarding issues (abuse or neglect) arise, these must be addressed quickly to protect the person.

Allergic Reactions

Feeds, equipment, or cleaning solutions can trigger allergies such as:

• Rashes, swelling, itching, or difficulty breathing.
• Serious reactions like anaphylaxis need swift medical attention.

Ensure all allergies are flagged in care plans and followed closely.

Final Thoughts

Extended feeding is a life-sustaining support but brings its own risks. These broadly include:

• Infection
• Tube blockages or displacement
• Aspiration and choking
• Gastrointestinal and nutritional problems
• Skin breakdown
• Emotional and psychological distress
• Equipment and mechanical failures
• Financial, practical, and legal issues
• Allergic reactions

Your awareness and regular checking play a central part in reducing these risks. Clear communication, following procedures, and putting the individual’s needs at the centre of care helps keep people safe and well during extended feeding.