Enteral nutrition is a method of delivering nutrition directly to the stomach or small intestine via a tube. Reasons for consideration of enteral nutrition include:
- Oral intake is insufficient to meet nutritional needs due to a possible range of factors which may include fatigue, cognitive impairment, agitation, decreased motivation.
- Reduced level of consciousness.
- Presence of a tracheostomy.
- Dysphagia.
- Gastrointestinal dysfunction or malabsorption.
- Increased nutritional requirements.
Enteral nutrition may be contraindicated in some circumstances, for example:
- Patients with a non-functioning gut i.e. the gastrointestinal tract is unable to absorb nutrients and/or fluids.
- When it is considered to be inappropriate for ethical reasons e.g. if the patient has written an Advance Directive setting out their wishes, if the patient has a terminal condition.
For further information, please refer to: Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition (NICE Feb 2006).
Following Acquired Brain Injury, the most common indication for enteral nutrition is dysphagia. Reasons for this may include:
- The patient is unable to take any nutrition/hydration orally because of a significant risk of aspiration and/or choking.
- Texture modification of food/fluid does not sufficiently reduce the risk of aspiration and choking.
- The patient may be unable to take sufficient quantities of food/fluid safely in order to meet nutritional and hydration requirements. They may require part of their requirements to be met via enteral nutrition.
Enteral nutrition should be administered by the most appropriate route for the patient. This will differ depending on the anticipated duration of enteral feeding, the ability to tolerate tube feeding and the potential for recovery of swallowing ability.
When considering enteral feeding following brain injury, the patient’s capacity to make informed decisions with regard to this intervention should be assessed by a suitably qualified professional. If the patient is assessed as lacking capacity and enteral feeding is deemed necessary, the Adults with Incapacity (Scotland) Act 2000 should be considered in order to legally proceed with the intervention. A Section 47 form will need to be completed by the responsible doctor.