Around 40% of hospitalised patients in Australia are affected by malnutrition.
Without nutritional support, these patients may deteriorate, leading to poor outcomes such as prolonged hospital stays, infection and compromised recovery (DAA 2018).
What is Enteral Feeding?
Enteral feeding is the delivery of liquid nutritional support through a tube inserted into the gastrointestinal tract. It is used for patients who are unable to meet their nutritional requirements through oral intake. This may be because:
Their oral intake is inadequate (e.g. poor appetite); or
They are physically unable to intake orally in a safe way (e.g. dysphagia, reduced level of consciousness).
Enteral feeding may complement oral intake or be used completely in place of oral intake (Dix 2018).
Under these standards, NDIS providers must meet the following quality indicators:
Clients are enabled to participate in the assessment and development of an enteral feeding and management plan. This plan identifies possible risks, incidents and emergencies, and what actions need to be taken to manage these situations, including the escalation of care, if necessary. The client’s health status is reviewed regularly (with the patient’s consent).
Staff members managing enteral feeding are informed by appropriate policies, procedures and training plans.
Staff members managing enteral feeding have received all necessary training from a qualified health practitioner or another appropriately qualified individual.
Reasons for Enteral Feeding
Enteral feeding is considered for patients who:
Are unable to meet their nutritional requirements through oral intake; and
Have a functional and accessible GI tract.
Generally, enteral feeding is needed if the patient is likely to have an inadequate oral intake for more than five to seven days (NHS 2015).
Patients with the following conditions may require enteral feeding:
Stroke (may impair swallowing);
Cancer (may cause loss of appetite);
Critical illness or injury (may reduce energy or ability to eat);
Failure to thrive or inability to eat in young children;
Serious illness (places the body under stress and makes it difficult to intake adequate nutrition);
Neurological or movement disorders (may make eating more physically difficult);
GI dysfunction or disease;
Cystic fibrosis; and
Mental health conditions such as depression and eating disorders.
(Dix 2018; NHS 2015)
Contraindications for Enteral Feeding
If the patient’s gastrointestinal tract is compromised (e.g. gut failure or intestinal obstruction) or inaccessible via an enteral tube, they may require parenteral nutrition instead. This involves nutrients being inserted directly into the bloodstream via a central venous catheter (DAA 2018).
Older adults or patients receiving palliative or end-of-life care may not be suitable for enteral feeding. You should take into account quality of life, possible complications and expected outcomes when making a decision (DAA 2018).
Routes of Enteral Feeding
There are three sites on the body where an enteral feeding tube can be inserted, and several types of tubes that can be used, each taking a different route. This will depend on:
The intended duration of the nutritional support;
The patient’s condition; and
Whether there is any trauma or obstruction that would impede access to a certain site.
Percutaneous endoscopic gastronomy tube
Surgically or radiologically inserted gastronomy tube
Duodenum (small intestine)
Jejunum (small intestine)
Surgical jejunostomy tube
Percutaneous endoscopic jejunostomy tube
Percutaneous endoscopic gastronomy and jejunal extension tube
(Adapted from WA Country Health Service 2019)
Enteral Tube Positioning
Before the commencement of feeding, you must ensure the tube is positioned correctly. Poor placement or tube migration can cause potentially life-threatening aspiration of feed (DAA 2018).
Placement must be confirmed through x-ray and by measuring the pH level of gastric aspirate (refer to your facility’s policies and procedures). A pH of less than 5.5 generally indicates that the tube is correctly positioned in the stomach (NHS 2016).
Other methods of confirming placement are not recommended as they are less accurate (DAA 2018).
Tube placement should be assessed:
After the initial insertion;
At least once per shift if the patient is on continuous feeding;
Before administering feed, fluid or medication;
If the patient complains of discomfort or feed reflux;
After the patient vomits, retches or coughs;
If the external tube length has changed;
If the fixation tape has come loose; and
If new, unexplained respiratory symptoms arise (e.g. breathlessness, wheezing, stridor), or oxygen saturation is reduced.
In addition to ensuring the tube is correctly positioned, you can also minimise the risk of aspiration by:
Elevating the head of the bed by 30 to 45 degrees during feeding and one hour afterwards.
Checking for signs of intolerance (emesis, abdominal distension, constipation);
Maintaining good airway management;
Maintaining oral hygiene.
(Souza 2018; Canterbury District Health Board 2016)
Caring for Enteral Tubes
Caring for enteral tubes may include:
Introducing food via the enteral tube according to the patient’s care plan;
Monitoring the rate and flow of feeding, and adjusting this if necessary;
Keeping the stoma area clean;
Identifying and reporting any signs of infection;
Ensuring the tube is positioned correctly;
Flushing and aspirating the tube;
Following relevant procedures to address malfunctions such as blockage;
Documenting a request to review the patient’s mealtime plan if required;
Liaising with health practitioners to explain or demonstrate requirements; and
Identifying and addressing symptoms that may require intervention (e.g. reflux, unexpected weight changes, dehydration, allergic reactions, poor chest health).
(NDIS 2018; WA Country Health Service 2019)
Monitoring Enteral Tubes
When caring for a patient with an enteral tube, it is important to regularly monitor the following:
Food chart (if applicable);
Fluid balance chart;
Presence of oedema;
Capillary blood glucose;
Nausea and vomiting;
Balloon water volume in balloon-retained tubes;
General patient condition;
The goals of providing nutritional support; and
The necessity of providing nutritional support.
(Bapen 2016; WA Country Health Service 2019)
Note: Refer to your facility’s policies and procedures for the frequency of monitoring.
Possible complications of enteral feeding include:
Accidental dislodgement/removal of the tube;
Candidiasis (may occur if the skin is exposed to tube leakage);
Chemical dermatitis (may occur if the skin is exposed to gastric fluid leakage);
Mouth discomfort or infection;
Reflux and vomiting;
Abdominal pain or distension;
(Canterbury District Health Board 2016; Bapen 2016)
Generally, any of the following should be reported to medical staff or appropriate personnel:
Redness, swelling, pain or leaking around the tube, which may indicate infection;
Abdominal distension or hardness; and
Migration of the tube.
(Canterbury District Health Board 2016)
Enteral feeding is important for providing nutritional support but can be dangerous if performed incorrectly. In order to avoid potentially life-threatening complications, correct and thorough care of the feeding tube is essential.
Note: This article is intended as a refresher and should not replace best-practice care. Always refer to your facility's policy on managing enteral feeding.