Enteral nutrition, commonly referred to as “tube feeding,” provides nutrition and hydration through a nasogastric, gastrostomy, or jejunostomy tube to the stomach or small intestine. Tube feedings are sometimes needed, especially during acute illnesses. Tube feeding may be recommended for people:
Enteral nutrition can be given continuously or as a bolus feeding, or a combination of both methods.
The decision to use a feeding tube must address the risks and benefits for the person. Before initiating specialized nutritional support, the person’s advance directives (if any) regarding the use of artificial nutrition and hydration should be reviewed. It is important to determine if the person will benefit from tube feeding or if assisted hand feeding will satisfy the person’s nutritional and hydration needs.
This webpage includes best practice guidelines, presentations, articles, posters, handouts and references for tube feeding.
Evidence-based best practice guidelines for tube feeding (PDF format)
These guidelines were adapted from National Guidelines Clearinghouse and the American Society of Parenteral and Enteral Nutrition. (A.S.P.E.N.). Included are benefits and risks of tube feeding, education and care planning, and management and treatment.
Best practice guidelines for administering tube feeding (PDF format)
These guidelines were adapted from National Guidelines Clearinghouse and the American Society of Parenteral and Enteral Nutrition. Included are administration techniques.
Tube feeding and medication administration guidelines (PDF format)
These guidelines were adapted from AHRQ Agency for Healthcare Research and Quality from the National Guidelines Clearinghouse. Included are medication administration techniques for tube feeding.
Tube feeding and advance care planning
This presentation was created by the Texas Department of Aging and Disability Services Quality Monitoring Program dietitians. It includes information about advance care planning; assessment; comprehensive care plans; the risks and benefits of tube feedings;, as well as alternatives to tube feeding. The target audience is clinical staff.
PowerPoint presentation in PDF format
PowerPoint presentation in HTML format
Tube feeding administration guidelines
This presentation was created by the Texas Department of Aging and Disability Services Quality Monitoring Program dietitians. It includes information about proper tube feeding techniques and potential complications. The target audience is clinical staff.
PowerPoint presentation in PDF format
PowerPoint presentation in HTML format
Medical futility in long-term care: Principles and process
This presentation was created by David Fine, M.D., for the Texas Department of Aging and Disability Services Geriatric Symposium in 2000. It includes definitions of medical futility, the process for resolving futility disputes under Texas law, clinical and financial impact of ethics consultation under Texas law at a tertiary care teaching hospital, and cultural changes necessary to deal with the evolving concept of medical futility. The target audience is clinical staff.
Enteral tube flushing: What you think may be the best practices may not be
This article, published in the American Journal of Nursing, summarizes a review of literature and current practices to determine the best liquid for flushing tubes, how often tubes should be flushed, or how to flush when administering medications. The article discusses nasogastric, gastrostomy, and gastrojejunostomy feeding tubes; the gastrostomy button; and the clinical indications for use. The target audience is clinical staff.
Keeping patients safe; Assuring that feeding tubes stay out of the lung (PDF format)
This issue of Safe Practices in Patient Care describes a University of Virginia study using a CO2 sensing procedure (either capnography or colorimetric sensing device) to enhance safety when inserting gastric tubes. It provides an overview of diagnostic procedures used to confirm placement of tubes, as well as information on the new WHO and JCAHO Patient Safety Initiative. Nurses can earn 1.5 contact hours (no charge) by reading both articles and passing a competency-based test. The target audience is clinical staff.
Enteral nutrition and hydration in long-term care (PDF format)
This issue of Safe Practices in Patient Care provides information on hydration and enteral nutrition for individuals of residing in long-term facilities, along with safe-practice guidelines for optimal therapy and preventing complications. The issue also contains an article on safe practices in long-term wound care. Nurses can earn 2 contact hours (no charge) by reading both articles and passing a competency-based test. The target audience is clinical staff.
Safe enteral tube feeding and hydration in home care (PDF format)
This issue of Safe Practices in Patient Care outlines the safe and effective delivery of home enteral nutrition, including techniques of tube feeding delivery, avoiding complications and how to incorporate tube feeding in the family’s schedule. This issue also contains an article on life with home enteral nutrition. Nurses can earn 1.1 free contact hours by reading both articles and passing a competency-based test. The target audience for this material is family members and all levels of staff.
Evidence-based practice for enteral feedings: Aspiration prevention strategies, bedside detection, and practice change
This article, published in MedSurg Nursing, discusses evidence-based practices for enteral feeding strategies for preventing aspiration. The target audience is clinical staff.
Drug Administration Through an Enteral Feeding Tubes
This article, published in the American Journal of Nursing, describes the factors to consider before administering a drug through a feeding tube, examines the gap between recommended and common practice, and discusses the most recent guidelines. The target audience is clinical staff.
“BE A.L.E.R.T.”
The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) launched a safety campaign, supported by Nestle HealthCare Nutrition, Inc., to promote safe enteral feeding. The “BE A.L.E.R.T.” poster reminds caregivers of five safe practices nurses should follow to help improve tube feeding safety .
“BE A.W.A.R.E.”
The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) launched a safety campaign, supported by Nestle HealthCare Nutrition, Inc., to promote safe enteral medication delivery. The BE A.W.A.R.E. poster focuses on five safe practices nurses should follow to improve medication safety using tube feeding.
Best practice tube feeding techniques (PDF format)
This handout, developed by the Texas Department of Aging and Disability Services Quality Monitoring Program dietitians, provides information on evidence-based best practice techniques and recommendations for providing and managing tube feeding for individuals living in long-term care facilities. The handout provides an overview of the most recent and relevant information for staff, caregivers, and individuals.
Tube feeding care plan example (PDF format)
Developed as a teaching tool by the Texas Department of Aging and Disability Services Quality Monitoring Program dietitians, this care plan example includes a scenario, multiple measurable goals, and individualized interventions for people with feeding tubes.
Feeding tube education form (PDF format)
Developed by the Texas Department of Aging and Disability Services Quality Monitoring Program dietitians, this form includes potential benefits, risks, and burdens associated with tube feeding. It also contains alternatives to tube feeding. The target audience is clinical staff.
Enteral feedings: Best practices (PDF format)
This fact sheet, developed by the Outreach Services of the Indiana Bureau of Quality Improvement Services, discusses best practices to promote safety in managing the care of people with feeding tubes, and helps develop agency policies and procedures. The importance of competency based training is also emphasized, including detailed instructions on procedures, protocols, and monitoring. The target audience is all levels of staff.
Deciding about tube feeding (PDF format)
This pamphlet, developed by St. Joseph’s Healthcare, is a guide for individuals, families and friends faced with difficult choices about tube feeding. It provides basic information about the types of tubes, the indications for tube feeding; problems encountered; and living wills and advance directives. The target audience for this material is all levels of staff.
For questions or comments, please contact us at TQM@dads.state.tx.us.
Updated: April 3, 2013