Synopsis
Select enteral access appropriately, confirm tube position without unsafe shortcuts, prescribe feed and water coherently, and prevent aspiration, metabolic, mechanical and medication-related harm.
- Use enteral feeding when oral intake is unsafe or inadequate but the gastrointestinal tract is sufficiently accessible and functional; the indication and intended duration determine access.
- Nasogastric tubes generally suit short-term gastric feeding, post-pyloric tubes help selected gastric-intolerance or aspiration situations, and gastrostomy or jejunostomy may serve longer-term needs.
- Before first use of a nasogastric tube, accept only aspirate pH within the endorsed safe range or an appropriately obtained and interpreted X-ray; never use whoosh, bubble, litmus or fluid appearance tests.
Key red flags
Acute cough, cyanosis, desaturation or respiratory distress during tube use requires immediate cessation, airway assessment and confirmation that feeding access has not entered or migrated toward the airway.
Investigation priorities
Provide the first-line endorsed initial placement check when aspirate is obtainable.
Management branches
Oral intake is unsafe or insufficient and enteral feeding offers a proportionate benefit.
- Confirm indication, expected duration, gastrointestinal function, refeeding risk, capacity and the agreed goals of treatment.
- Choose gastric or post-pyloric access with the nutrition, endoscopy, radiology or surgical team according to anatomy and aspiration factors.
Key medicines
Prescribed enteral feed formulaDeliver the dietitian-approved volume by the specified continuous, intermittent or bolus schedule, with staged introduction where tolerance or refeeding risk requires it.
Thiamine for high refeeding riskGive immediately before and during early feeding using the current NICE-aligned local regimen and an absorbable route.