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Tube Feeding Error: Fatal Medical Mistakes
Date:7/15/2009

Recent Death of Infant in Madrid Brings Issue to Forefront

SILVER SPRING, Md., July 15 /PRNewswire-USNewswire/ -- The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), whose mission is to improve patient care by advancing the science and practice of nutrition support therapy, is saddened by the recent death of an infant in Madrid, Spain, who died when formula was given to him through an IV catheter and not through a feeding tube in his stomach.

"This type of tube feeding error, or enteral misconnection, is preventable," said Peggi Guenter, PhD, RN, CNSN, director of clinical practice, advocacy, and research affairs for A.S.P.E.N. "Best practices in EN require a comprehensive understanding by healthcare practitioners and changes to clinical and organizational processes. That's why A.S.P.E.N. works every day to provide research, training and guidelines and standards so that healthcare professionals have the knowledge they need to prevent these deadly mistakes."

Patients receiving enteral nutrition, sometimes referred to as "tube feeding," are unable to feed themselves and are frequently among the most critically ill. EN is the delivery of food directly into the gastrointestinal tract (GI) through a tube placed in the nose, the stomach or the small intestines. These patients often have many other types of tubes such as IVs, oxygen, or drainage tubes in them.

It's not the first time an enteral misconnection has caused a death; the first one was reported in 1973. In addition to this week's incident in Madrid, A.S.P.E.N. staff recently learned about the case of a young pregnant woman who was erroneously given tube feeding formula into her IV line, resulting in the death of her 35-week fetus, and shortly thereafter, her death.

A.S.P.E.N. is at the forefront of providing guidelines and standards,
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SOURCE The American Society for Parenteral and Enteral Nutrition
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