Enteral nutrition involves the administration of food and fluids via a tube into the stomach, duodenum or jejunum. Whenever possible, oral food intake is always preferred. Enteral feeding is used for adults or children whose nutritional needs cannot be met orally and they are at risk of weight loss and/or malnutrition. Examples of the patient group include dysphagic patients (e.g. cancer and neurological conditions), food/fluid refusal, and patients with gastrointestinal problems.
In Doncaster & Bassetlaw the enteral feeding contracted supplier for delivery, pharmacy and nursing service is Nutricia. Further information can be found below:
Enteral Feeding Contract – Bassetlaw & Doncaster Health Economy
This page is appropriate for patients, carers and healthcare professionals and provides information regarding enteral feeding tubes.
Decision Making for Tube Placement
The decision to have a feeding tube placed is initiated in either primary or secondary care and a thorough assessment is made of a patient suitability. The clinical decision to propose an enteral tube as part of clinical treatment should be made by the relevant and involved Multi-Disciplinary Team (MDT). Patients and their carers and families are supported to make decisions regarding tube feeding by dietitians, specialist nurses and consultants involved in their care.
Please watch the video below for more information on this:
The information below provides advice on how to care for the different feeding tubes:
PEG/J Tubes
Please read the written information before referring to the video guidance:
Percutaneous Endoscopic Gastrostomy (PEG) Tube
Video guidance:
Y adaptors should only be changed when broken or permanently soiled. As standard all patients receive 1 every 6 months and a spare should always be kept.
BG Tubes
Please read the written information before referring to the video guidance:
Video guidance:
Balloon water should be changed once weekly, and full replacement of the BG tube or button changed every 3 months by the enteral nurse specialist or trained person.
Other Feeding Tubes
For RIG, PIGG, PEG-J’s or transgastric tubes please contact the Enteral Nurse Specialist (Nutricia) for advice on the care needs.
Measuring Aspirate
Please read the written information before referring to the video guidance:
Measure the pH of Gastric Aspirate
Feeding via a Tube
Nutricia provides enteral feed delivery to patients receiving tube feeding in the community. The dietetic teams within Doncaster work closely with Nutricia to manage the care of the patients.
Patients will receive feed either via a feeding pump or bolused with a syringe or a combination of the two. Feeds come in a variety of bottles and bags. Oral nutritional supplements can also be used for bolus feeding.
Please read the written information before referring to the video guidance:
How to Set Up a Pump Feed/Pump Training
Trouble Shooting & Pump Alarms – Step by Step Guide
Administration via Syringes
All patients are provided with enough 60ml syringes for administration of feed, fluid or medications. This is for all ages groups.
Patients who have a balloon retained tube in place are provided with a 5 or 10ml luer-slip syringe to enable balloon water to be changed.
- 60ml syringes can be used for dosing any medication volume 10ml and above but are not accurate for volumes under 10ml.
- Volumes between 5ml and 10ml can be measured as anyone with an oral intake would. Such as with a medicine spoon or a syringe such as you receive with the medication.
- Volumes under 5ml will require a more accurate syringe that should be provided by the prescriber/dispenser.
Once correctly measured the medication should then be poured into medicines pots or a clean glass and usually mixed with a small volume of water and administered then via the 60ml syringe.
Syringes can be washed using warm soapy water and airdried for re-use. They can then be stored in a clean, cool dry place. The average usage is between 1-2 syringes per week.
Nutricia Nursing Service
Nutricia Homeward provide an Enteral Nurse Specialist (ENS) service to all adult patients and work in conjunction with the community children’s nurse for paediatric patients.
Training to patients, family and carers on how to manage a tube, stoma site and how to administer feed, fluid and medications is provided by the Nutricia ENS. The Nutricia ENS service will carry out regular routine reviews of the patients enteral feeding tube and this will also include a stock check. For some patients the Nutricia ENS will arrange regular tube changes for patients with balloon retained tubes.
A trouble shooting service is also offered and patients will have a contact number for the nurse or 24 hour help via the Nutricia Careline (see below).
Accidental Tube Removal
If a tube is accidentally removed maintaining the tract is paramount, the tract can heal within a 2hr timeframe so insertion of a ‘plug’ is classed as urgent.
- If the patient has an established stoma tract of 4 weeks or more and their balloon gastrostomy or PEG is accidental removed an EnPlug can be inserted to maintain the tract.
- If the tract of the feeding tube has been established less than 4 weeks the site should be covered with a dry dressing and the patient should attend A+E immediately.
Patients and carers are advised to call the Nutricia nurse 24 hr helpline in the first instance and if there is a nurse available they will attend to replace the tube.
If no nurse is available and the patient is in the Doncaster area they will be advised to call Single Point of Access and a community nurse from the emergency team can attend and insert an EnPlug.
A risk assessment should then be performed by the attending nurse to ascertain whether the patient requires hospital admission for IV fluid/medicines or if they are safe to stay at home until a Nutricia nurse can visit the following day.
If you are providing care and feeding a patient with an enteral feeding tube, please complete all the Nutricia e-learning modules available via the training package:
Please register with an email address and create your own password.
On receipt of a confirmation email, please access the e-learning using the enrolment key nurse2020.
Documentation
If you are caring for a patient with a feeding tube, it is advised to keep a record and complete the following charts:
N.b. Daily feed provided should be on the person’s medication chart.
Decision Making Post Tube Placement
As a patient’s condition changes it may be agreed with the patient or a best interest decision is made to withdraw artificial nutrition and hydration. The dietetic teams from RDaSH and DBTH and the Nutricia Homeward Enteral Nurse Specialists may instigate this decision-making process with the GP and are able to provide the necessary information to support it to ensure the patient, family and carers have the required support and information.
Healthcare professional only guidance:
Clinically-assisted nutrition and hydration and the decision-making process
Contact Information
Nutricia Homeward – Healthcare Professionals
| Problem | Contact | Details |
|---|---|---|
| Enteral Feed and/or Fluid | Dietetic Service | RDaSH: 01302 796410 DRI: 01302 642742 |
| Tube Problems / Training Requests / Tube Displacement
Monday to Friday 8am to 6pm Saturday to Sunday 9am to 1pm Saturday to Sunday 1pm to 5pm Out of Hours |
Enteral Nurse Specialist (Nutricia)
Doncaster Royal Infirmary Endoscopy Department Enteral Nurse Specialist (Nutricia) |
0345 762 3670
nutricianurse.careline@nhs.net
01302 644171 0800 093 3672 |
| Feeding Tube Ancillaries & Deliveries | Nutricia Homeward Coordinator | 0800 093 3671 |
| Medications | Your local GP or pharmacy | |