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Survival Among Severely Cognitively Impaired Tube-Fed Nursing Home Residents-Reply

Susan L. Mitchell, MD, MPH, FRCPC; Dan K. Kiely, MPH
Arch Intern Med. 1997;157(15):1770. doi:10.1001/archinte.1997.00440360216028.
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Gomolin correctly raises the possibility that tube-fed nursing residents may continue to aspirate salivary and nasal secretions despite the presence of the feeding tube. In our sample of 135 tube-fed severely cognitively impaired nursing home residents,1 only 20 received suctioning based on information in the Minimum Data Set. Unfortunately, this sample is too small to perform a survival analysis comparing tube-fed residents who received suctioning with those who did not.

However, a major source of aspiration among tube-fed nursing home residents, other than nasal and salivary secretions, is regurgitation of gastric contents, particularly the nutritional products given via the feeding tube.2 Aspiration occurs with both gastrostomy and jejunostomy tubes.3 Proper positioning can help minimize this complication. However, it is unlikely that suctioning would have much effect.

Finally, frequent suctioning of severely cognitively impaired, institutionalized, elderly residents with feeding tubes could be quite uncomfortable for the patients, even


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