Enteral Feeding Script

……. Has not been alert enough or able to follow the instructions required for a full swallow examination. As she has been in hospital for over a month and has not been able to participate in assessment she is likely to need enteral (artificial) feeding in the long term. If ….. becomes more alert the speech and language therapist will assess her swallowing and start to develop a therapy program.

There are two main types of enteral feeding, Naso-gastric feeding and PEG (percutaneous endoscopic gastrostomy) feeding.

Advantages and disadvantages

Naso-gastric feeding           NG-tubes are typically used for under 30 days.	PEG Feeding           A feeding tube is placed through the abdominal wall directly into the stomach. Mild anaesthetic can be used and the procedure is non-surgical.
Advantages          NG –tube placement is a quick    procedure.          No surgery is required.          NG- tubes can be removed easily.	Advantages             Patients are less likely to pull out a PEG than an NG-tube.             PEG’s can be kept for feeding in the long term.
Disadvantages  Patients may find the NG-tube uncomfortable. Patients may pull out the NG- tube as ….. has done. Regular re-insertion of the NG-tube can be traumatic for patients. Risk of aspiration (liquid/solids going into the patients lungs) if the tube is displaced. Regular x-ray’s may be required to check placement of the tube. Patients are therefore not normally discharged into the community or into nursing homes with NG-tubes.  NG-tube feeding can cause diarrhea, vomiting and cramping.	Disadvantages             If the patient is not medically stable or is unwell they will not be safe to undergo the PEG procedure. -

We have recommended PEG feeding because: 1. …. Has removed her NG-tubes multiple times and has been unable to receive nutrition/ medication when the tube is not in place. 2. No constraints e.g. the mittens, need to be used so the patient is free to use her left hand in therapy/ to communicate and 3. The PEG can be used in the long term.