Enteral Nutrition

Enteral nutrition is when a liquid feed is given through a tube inserted into the gut. This is commonly because of an inability to safely take food by mouth (examples of reasons for this could be stoke, motor neurone disease, cerebral palsy or head and neck cancer or trauma).  The tube may reach the gut by being passed through the nose and into the stomach or small bowel (naso-gastric or naso-jejunal tubes). A tube that passes through the stomach or jejunum may be inserted in the endoscopy department, in the x-ray department or in an operating theatre.

Knowing the type of tube and where/how it was placed is important (see table).

Once an enteral feeding tube is in place feeding can be by two different methods.

1. A bolus (a large volume of feed) when usually 150-500 ml of feed is given into the stomach 3-5 times a day as advised by the dietitian. A large volume of feed can be given quickly into the stomach; this is because the stomach has a reservoir function of storing food/fluid before delivering it slowly to the small bowel. This is how we normally eat.
2. Continuous feeding is when the feed is given over 8-24 hours (most commonly overnight 10-12 hours) with a pump controlling the rate at which the feed is administered.

These methods may be used in combination (e.g. 1-2 bolus feeds in the day and a continuous night time feed). Rarely the feed is given by intermittent gravity drip when a giving set and bag are connected to the tube and the volume is given over 30-60 min by a slow drip. A hygienic clean technique is used to set up the feeds.

Naso-gastric tubes need to have their tip position checked before each feed. A small volume of gastric aspirate has its pH tested with CE marked pH indicator paper to ensure the tube is in the stomach.

If the patient or carer is unsure about the procedures or wishes to better understand the procedure they should contact the hospital nutrition nurse specialist or dietitian.

Information and illustrations provided by The Nightingale Trust