Feeding tube and do not resuscitate

Posted by scooter8484 @scooter8484, Jul 26 9:43am

My 95 year old grandma in Illinois just had a stroke in which she became paralyzed on her right side. The doctors are going to discuss feeding arrangements today, but she can't chew or swallow. Does living permanently with a feeding tube fall under the do not resuscitate form?

Such a good question, @scooter8484. I'm afraid the answer may not be straight forward. Strictly speaking a do not resuscitate order (DNR) is a request not to have CPR if your heart stops or if you stop breathing. A DNR can be part of an advance directive. One's wishes regarding things like ventilation and feeding tubes can also be added to an advance directive. They are not specifically part of DNR. Sometimes people think DNR means "do not treat," but it doesn't.

Here's some information that might help explain further.
– Advance Directives and Do Not Resuscitate Orders https://familydoctor.org/advance-directives-and-do-not-resuscitate-orders/
– Deciding about Tube Feeding https://www.stjoes.ca/pdfs/PD3307_Deciding_Tube_Feeding(Internal).pdf

Is your grandma able to communicate at all? Is she able to take part in the decision to have a feeding tube or not?

REPLY
@colleenyoung

Such a good question, @scooter8484. I'm afraid the answer may not be straight forward. Strictly speaking a do not resuscitate order (DNR) is a request not to have CPR if your heart stops or if you stop breathing. A DNR can be part of an advance directive. One's wishes regarding things like ventilation and feeding tubes can also be added to an advance directive. They are not specifically part of DNR. Sometimes people think DNR means "do not treat," but it doesn't.

Here's some information that might help explain further.
– Advance Directives and Do Not Resuscitate Orders https://familydoctor.org/advance-directives-and-do-not-resuscitate-orders/
– Deciding about Tube Feeding https://www.stjoes.ca/pdfs/PD3307_Deciding_Tube_Feeding(Internal).pdf

Is your grandma able to communicate at all? Is she able to take part in the decision to have a feeding tube or not?

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Thank you very much. Shes able to talk but she slurs her speech. She declined a feeding tube late this evening and is eating very slowly.

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@scooter8484

Thank you very much. Shes able to talk but she slurs her speech. She declined a feeding tube late this evening and is eating very slowly.

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@scooter8484 I am sorry about your grandma. I thought I could offer some information about feeding tubes since my dad had one for a long time. Initially, he had one because of a head injury and lost the ability to swallow and was in his mid sixties at the time. His recovery took several months and eventually he relearned how to swallow and the tube was removed. As he aged, he had trouble swallowing correctly. He never did it particularly well, but in his 80's he was starting to choke on food and aspirate and had pneumonia because of it. There were swallowing tests he failed, and he had a feeding tube again. The stomach shrinks when it doesn't regularly get stretched with food volume which affects liquid feeding because that will pass much slower through a much smaller stomach. With my dad, it was set up like an IV drip that was connected to his tube, and sometimes it took an hour or more to get the liquid into him. If the drip went too fast, it could back up in his throat and choke him causing aspiration. If that happened, the line could be disconnected, and the feeding tube opened to drain stomach content quickly which I had to do a few times. The patient has to be sitting up to do this and can't recline, at least not more than 45 degrees because of the aspiration and choking risk. Eventually the stomach can't really tolerate this and the choking/aspiration risk is always there. That is how my dad passed after aspirating which then caused a heart attack. I had discussed that possibility with his doctors a couple weeks before it happened and I knew to expect this. I hope that gives you some understanding of the problems of managing a feeding tube. They can also become infected and need to be replaced. You need to clean around them on the skin surface daily and flush them with water after use. They can also be pulled out by the patient possibly unknowingly if dementia is involved.

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