As Terri Schiavo’s parents continued their battle to have the Florida woman’s stomach feeding tube restored, Pope John Paul II yesterday began receiving nutrition from a tube placed in his nose, the Vatican announced.
“There are several ways to feed a patient” who has difficulty swallowing, or can’t swallow, said Dr. Michael Gauderer, director of surgery at Greenville Children’s Hospital in South Carolina.
He said one method uses a device known as the “nasogastric tube,” which the pope received yesterday. “It’s a thin, long tube made of a special plastic that’s about two-thirds the diameter of a pencil” that’s threaded through the nose “down the food pipe into the stomach,” Dr. Gauderer said in a telephone interview.
Dr. Arthur St. Andre, director of surgical critical care services at Washington Hospital Center, said that in patients with Parkinson’s, such as the pope, “food particles can go into the trachea and into the lungs, rather than down the esophagus into the stomach.” A nasogastric tube makes sure they reach the proper destination.
Dr. Gauderer noted that another version of the nasogastric tube — one that is slightly wider in diameter — is commonly used in hospitals for stomach decompression after major intestinal surgery.
The South Carolina physician knows a lot about the type of feeding tube Mrs. Schiavo has lived with for 15 years. In 1979, he was co-developer of a procedure known as percutaneous endoscopic gastrostomy (PEG), which involves making a “pinprick” in the abdomen so a feeding tube can be passed directly into the stomach.
Before PEG, insertion of a feeding tube required a large incision and major surgery, Dr. Gauderer said.
Nasogastric tubes tend to be used for shorter terms than those employed in PEG. “Unfortunately, the pope’s condition is not temporary. And unless he regains strength, it’s likely he will have to have a more permanent feeding tube, similar to Terri Schiavo’s, inserted into his stomach,” said Dr. St. Andre.
Dr. Gauderer agreed. “If doctors predict the pope will need a feeding tube for months or years, he would be better off having a tube placed directly into his stomach.”
Complications such as pneumonia and blood infections have been associated with feeding tubes. As for those put in the nose, Dr. St. Andre said they are “uncomfortable” and can cause other complications, such as sinusitis and a “breakdown in nose tissue that’s analogous to bedsores.”
Dr. Gauderer said PEG is used about 279,000 times yearly in the United States. He could not provide figures on the use of nasogastric tubes.
Dr. Sean Morrison, professor of palliative medicine at the Mount Sinai School of Medicine in New York, yesterday told the Associated Press that reinserting Mrs. Schiavo’s feeding tube could hasten her death, if her kidneys have already shut down. That’s because the tube would be supplying fluids to a body that can no longer get rid of them.
Dr. St. Andre said: “If kidney function has been compromised, there’s a chance of electrolyte disturbance, which could cause rapid heart dysfunction. Or there could be a slow buildup of normal toxic products that could cause dysfunction of all organs.”