DDX of feeding tube malfunction

Approach to the DDX of feeding tube malfunction:

  • A feeding tube tip that crosses to the right of the spine and then heads superiorly before turning back to the left of the spine is most likely still in the stomach
  • A feeding tube tip that crosses to the right of the spine and then heads inferiorly before turning back to the left of the spine is most likely in the duodenum or jejunum
  • The correct position of the feeding tube tip is near the duodenal-jejunal junction or in the proximal jejunum. Placement or migration once placed into a position proximal to this may lead to reflux of feedings into the stomach and thus feeding tube malfunction
  • Placement of the feeding tube tip into the airway can result in pneumothorax or aspiration with feedings
  • Perforation of the gastrointestinal tract would be suspected if free air is noted on the AXR after placement
  • Kinking of the feeding tube tip leading to its obstruction should be investigated for in a feeding tube that was working well but no longer works
  • Migration of the feeding tube tip out of the duodenum is a rare complication