title: Bleeding Associated With Feeding Tube Placement in Critically Ill Oncology Patients With Thrombocytopenia.
abstract: BACKGROUND
  Existing trials have not evaluated the feasibility of oral or nasal feeding tube (FT) placement in the critically ill thrombocytopenic oncology population. Thrombocytopenia (TCP) may be considered a contraindication to FT placement due to the potential risk of bleeding complications.
  
  
  METHODS
  Medical intensive care unit (ICU) adult oncology patients with attempted nasal or oral FT placement were evaluated in a 52-bed ICU at a comprehensive cancer center. End points were compared between patients with and without TCP (platelet count <150,000/μL). Primary outcomes of overt and clinically important bleeding (gastrointestinal and point of entry) were evaluated within 72 hours of FT placement.
  
  
  RESULTS
  Fifty-nine patients were enrolled (TCP, n = 42; no TCP, n = 17; baseline platelet count, 41 ± 48 vs 249 ± 85 [× 10(3)/μL], P < .001). Patients with TCP were more likely to have a hematologic malignancy and lower baseline hemoglobin and platelet count (P < .01). More patients with TCP received blood products 24 hours prior to FT placement (86% vs 12%, P < .01). There was no difference in overt (7.1% vs 0%, P = .55) or clinically important (2.4% vs 5.9%, P = .5) bleeding complications within 72 hours of attempted FT placement among patients with TCP versus those without.
  
  
  CONCLUSIONS
  Critically ill oncology patients with TCP do not appear to be at a higher risk for bleeding complications after FT placement compared with those without TCP, which may be related to blood product transfusion within 24 hours prior to FT placement.
authors: Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas rppatel1@mdanderson.org.
authors: Rina P
authors: RP
authors: Patel
authors: Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Todd W
authors: TW
authors: Canada
authors: Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Joseph L
authors: JL
authors: Nates
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000628:therapy; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications / Q000628:therapy*; D010976:Platelet Count; D012307:Risk Factors; D013921:Thrombocytopenia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D013997:Time Factors
chemical_list: D006454:Hemoglobins
keywords: critical care; critical illness; enteral nutrition; hemorrhage; oncology; thrombocytopenia