Abstract TP348: Discharge to Acute Inpatient Rehabilitation with a Nasogastric Feeding Tube Safely Decreases Delays in Discharge and Avoids Unnecessary Percutaneous Gastrostomy Tube Placement

Introduction: AHA Guidelines for the Management of Patients with Acute Ischemic Stroke recommends PEG placement in patients with persistent inability to swallow safely 2-3 weeks after their stroke, 1 and evidence demonstrated that patients had better functional outcomes when they received feeding through a NGT as compared to a PEG for the first 2-3 weeks. 2 At our stroke center, patients are typically ready for acute inpatient rehab prior to the 2-3 week decision point for PEG placement, but unfortunately there were no AIRs in the state that accepted patients with NG feeding tubes. This prolonged hospitalizations and delayed access to much needed therapies. Collaborating with our affiliated AIR, we developed a multidisciplinary plan to safely care for stroke patients with a NGT in place during the 2-3 week period following acute stroke. Methodology: Based primarily on speech language pathologists’ evaluations, we identified patients who were likely to recover their ability to swallow safely and take in adequate nutrition within three weeks of their stroke and proposed transferring these patients to our affiliated AIR. This included patients who had been cleared for a PO diet but needed supplemental tube feedings to meet nutritional needs and patients who were completely NPO. These patients were then followed by the stroke team NP while at AIR, monitoring patients for NGT related complications, duration of NGT use and placement as well as the possible need for PEG placement in those with persistent oropharyngeal dysphagia. Results: From September, 2023 to May, 2025, we transferred 20 patients to AIR with NGT tubes in place. There were no significant NGT tube related complications. One patient returned to the ED to have their NGT replaced. Three patients were readmitted to the hospital, but none of these readmissions were related to dysphagia, aspiration or the NGT itself. All three readmissions were cleared for a PO diet during the subsequent hospitalization and ultimately returned to AIR. Three patients eventually required a PEG to be placed. The average number of days with an NGT at AIR was 16 days and median was 12 days. Conclusion: It is feasible and safe to send selected patients to AIR with an NGT in use for nutritional feedings in the 2-3 week period following a stroke. In our small sample, we encountered no significant NGT related complications and 85% of the patients ultimately avoided PEG placement.