Enteral nutrition is often considered to be simpler than parenteral nutrition. Although nasogastric feeding is relatively common in hospital and gastrostomy feeding is the most common form of tube feeding in the community, in the past few decades more complex enteral access routes have become available and these may require specialist intervention by healthcare professionals, both for tube insertion and maintenance.
Despite the frequent use of nasogastric tubes for nutrition, an excellent standard of care is needed to avoid the hazard of feeding down an inappropriately placed nasogastric tube - this is a “never event” in NHS England (http://www.nrls.npsa.nhs.uk/resources/collections/never-events/core-list/misplaced-naso-or-orogastric-tube-not-detected-prior-to-use/). pH testing of aspirate is the recommended first-line method of checking tip position for nasogastric tubes and Chest X-ray second-line. X-rays must be interpreted by appropriately trained staff as misinterpretation has been the cause of a number of complications and deaths.
Some of the table below may not be visible at smaller screen sizes – Download the table as a PDF
Tube type | Timeframe | Common indications | Common Insertion methods | Hazards | Key interventions | Common issues |
---|---|---|---|---|---|---|
Naso-gastric Fine bore feeding tubes ≤12fr |
Short-term- generally less than 30 days |
|
|
Ensuring tip in stomach www.nnng.org.uk/download-guidelines/ |
pH of aspirate on insertion then prior to every tube use/ daily if fed over 24 hours to check tip position. Also check if- 1) Any new or unexplained respiratory symptoms or if oxygen saturations decrease. 2) Episodes of vomiting, retching or coughing spasms. |
Repeated displacement
nnng.org.uk/download-guidelines/ Blockage
|
Naso-jejunal |
Short-term - generally less than 90 days |
|
|
Insertion more complex |
Xray after insertion to check tip position then if tube moves or symptoms. |
Blockage
Displacement
|
Gastrostomy |
Long-term – generally more than 30 days |
|
|
Inadequate assessment before insertion Complications of insertion – peritonitis/inadvertent puncture of colon/bleeding/infection, risk of aspiration Displacement |
Advance/Rotation 1-2weekly pH check if tube replaced appropriate 72 hour post procedure care |
Displacement
Local leakage
Abscess
Buried bumper Damage to tube
|
Jejunostomy |
Long-term - generally over 30 days |
|
|
More difficult to insert than gastrostomy Complications of insertion – peritonitis/inadvertent puncture of colon/bleeding/infection Extensions liable to displacement Small bowel volvulus |
|
Displacement
Blockage
Local leakage
Abscess
Damage to tube
|
https://www.bsg.org.uk/resource/bsg-guidelines-for-enteral-feeding-in-adult-hospital-patients.html