Indications for enteral nutrition in adults

Enteral nutrition should be considered if oral intake is unsafe or inadequate to meet the patient’s nutrient requirementsNational Institute for Clinical Excellence (NICE), 2006. Enteral nutrition is safe and cost effective and is preferred over parenteral nutrition when the gastrointestinal tract is functional.

Enteral nutrition support may be preferred to oral nutrition support in adults who are malnourished or are at risk of malnutrition due to chronic or critical illness, anorexia nervosa, trauma to the head or neck, oropharyngeal or oesophageal tumours, upper gastrointestinal surgery, severe pancreatitis or impaired swallowing from neurological disorders (eg stroke, multiple sclerosis, motor neurone disease, cerebral palsy).

Decisions about starting or continuing enteral feeding should take into consideration the patient’s (or substitute health decision maker’s) wishes, potential benefits (including improved quality of life), possible complications and expected outcomes. Patients should be assessed by a multidisciplinary nutrition support team before gastrostomy insertionNational Institute for Clinical Excellence (NICE), 2006.

Risk feeding (ie when a person continues to eat and drink despite significant risk of aspiration or choking) may be acceptable for some patients following an informed discussion with the patient or the substitute health decision makers.

In patients with advanced dementia, decisions about enteral feeding should also involve development (or review) of a holistic advance care plan, in consultation with substitute health decision makers. These patients are generally not considered appropriate for enteral nutrition support because it does not improve survival compared to careful handfeedingDavies, 2021. In some patients with advanced dementia, the advance care plan may include the provision of risk feeding. Patients with advanced dementia may benefit from speech pathologist referral for assessment of swallowing and feedingGuideline Adaptation Committee, 2016.