Enteral tube feeding in adults.

Enteral tube feeding is usually a relatively straightforward method of nutritional support, and should be facilitated by a multiprofessional team. For short-term use (<4 weeks) a fine bore feeding nasogastric tube is indicated but if longer term feeding is required then a gastrostomy is appropriate, usually inserted endoscopically (a percutaneous endoscopic gastrostomy tube). The most common serious complication of a nasogastric tube is not identifying a misplaced tube within the lungs: there are clear recommendations from the National Patient Safety Agency as to how to check tube placement. Nasojejunal tubes are required in patients with gastroparesis. Tube blockage is common and is prevented by careful and regular flushing. Diarrhoea is the most complication of feeding and is often related to other medication. Clinicians need an algorithm for systematically dealing with such a problem. Refeeding syndrome may occur in malnourished patients and is characterised by low levels of potassium, phosphate, and/or magnesium, as well as disorders of water and salt balance. Identifying the at-risk patient with careful monitoring is crucial.