Causes of Vomiting During Nasogastric Tube Feeding in Stroke Patients

Primary Mechanical Causes

Pharyngeal coiling of the nasogastric tube is a frequent cause of feeding intolerance and vomiting in stroke patients, as demonstrated where worsening dysphagia symptoms were primarily due to tube coiling in the pharynx rather than the tube itself affecting swallowing 1
Tube dislodgement is a common problem in daily routine with nasogastric tubes, leading to poor enteral nutrition delivery and potential feeding into incorrect locations 2
The American Society for Parenteral and Enteral Nutrition recommends radiographic confirmation of tube position is mandatory before initiating feeding to prevent complications from misplacement 3
If vomiting occurs, endoscopic evaluation of the pharyngeal tube position or tube reinsertion is recommended 1

Rapid feeding rate or excessive volume can overwhelm gastric capacity, particularly in the acute phase when intestinal tolerance is limited, according to the Clinical Nutrition guidelines 4
Feeding should be initiated at low flow rates (10-20 ml/h) in acute stroke patients, as it may take 5-7 days to reach target nutritional intake, as suggested by the Praxis Medical Insights 4

The American College of Gastroenterology recommends using small diameter tubes (8 French) to minimize pressure sores and improve tolerance 1
For mechanically ventilated stroke patients requiring prolonged feeding (>14 days), early PEG placement within 1 week is superior to nasogastric tube feeding due to lower ventilator-associated pneumonia rates and better tolerance, as stated by the Clinical Nutrition and Praxis Medical Insights guidelines 2, 3