4.2.2 Guidelines: Theory to practice for enhanced patient care
Practical guidance for healthcare professionals about how to manage enteral tube feeding both in hospitals and in the community, including the transition from one to the other, is essential and should be a key component of many guidelines. Enteral tube feeding should be viewed as an integral part of the nutrition care process, and the decision to initiate the organisation and planning of ETF should be managed within this context.
The decision to initiate and the implementation of ETF is often a complex, multidisciplinary, and multi-agency process. Initiating enteral tube feeding may also involve ethical decisions, particularly in vulnerable patient groups such as in older people, in paediatrics, and in patients without capacity to participate in the decision-making process. Whilst these issues need to be considered on a patient level, the practicalities and management of the feeding process itself are easier to document. As a result, some internationally recognised organisations have produced practical guidance for healthcare providers to facilitate this process. Some of these key guidance documents are summarised in Table 4.30.
Overview of key publications focusing on the practical implementation of enteral tube feeding
| Country/ region | Organisation | Ages | Title | Content |
|---|---|---|---|---|
| US | American Society for Parenteral and Enteral Nutrition | All ages and practice settings | Enteral Nutrition Practice Recommendations (2009) 68 | Focuses on the practice of enteral feeding and not the decision to initiate. Includes the following headings:
|
| US | ASPEN | All ages and practice settings | ASPEN Enteral Nutrition Handbook, 2nd Edition 71 |
|
| US | American Society for Parenteral and Enteral Nutrition | Paediatric and adult patients | A.S.P.E.N. Standards for Nutrition Support: Home and Alternate Site Care (2014) 4 | Provides practice-based standards which are intended for use by healthcare professionals charged with the care of patients receiving nutrition support therapies in the home or alternate site care settings. Covers all aspects of the nutritional care process. |
| UK | National Institute for Health and Care Excellence (NICE) | All patients in hospital and community | Nutrition Support Quality Standard 24 (2012)72,73 | Statement 4. People managing their own artificial nutrition support and/or their carers are trained to manage their nutrition delivery system and monitor their wellbeing. Statement 5. People receiving nutrition support are offered a review of the indications, route, risks, benefits, and goals of nutrition support at planned intervals. |
| Europe | European Society for paediatric gastroenterology, hepatology and nutrition (ESPGHAN) | Paediatrics | Practical Approach to Paediat- ric Enteral Nutrition: A Comment by the ESPGHAN Committee on Nutrition (2010) 15 The Use of Blended Diets in Children With Enteral Feeding Tubes 74 |
Provides a clinical practice guide to enteral nutrition support (ENS) in paediatric patients. This document offers recommendations for healthcare professionals managing blended diets in paediatric patients requiring enteral feeding. |
| Europe | European Society for paediatric gastroenterology, hepatology and nutrition (ESPGHAN) | Paediatrics | ESPGHAN Position Paper on Management of Percutane- ous Endoscopic Gastrostomy in Children and Adolescents (2015) 75 Percutaneous endoscopic gastrostomy in children: an update to the ESPGHAN position paper 2021 76 |
Provides a comprehensive guide for health care providers to manage percutaneous endoscopic gastrostomy tubes in a safe, effective, and appropriate way. Update: Expanded Indications: The updated paper provides a more comprehensive overview of the indications for PEG placement in paediatric patients, considering recent clinical evidence. Technique Enhancements: Advancements in PEG placement techniques, including the use of single-stage procedures and laparoscopic-assisted methods, are discussed. Complication Management: The paper offers updated recommendations on the prevention and management of potential complications associated with PEG in children. Post-Procedure Care: Guidance on post-procedural care, including feeding initiation and stoma management, has been refined based on recent studies. |