Enteral Tube Feeding - for health professionals

The Somerset Home Enteral Tube Feeding Service (HETF) provides dietetics assessment and advice for adult and paediatric patients who have a feeding tube and are registered with a GP practice in Somerset.

The Somerset HETF service works closely with Nutricia who have the current contract to supply feed and equipment to patients receiving enteral feeding in the community.

The Somerset HETF service in an ‘off-script’ account which means that the feed can be delivered directly to the patient from Nutricia without the need for a prescription.

Referral criteria

The patient MUST be registered with a Somerset GP.

The patient has an enteral feeding tube in situ.  
The Somerset Home Enteral Feeding team is unable to initiate naso-gastric, naso-jejunal or jejunostomy feeding within the community setting and will advise the need for a hospital admission.
Jejunostomy tube changes will also require an acute hospital admission. Radiologically inserted gastrostomy (RIG) tube changes before 12 weeks will also require an acute hospital admission. It is the responsibility of the acute hospital trust to arrange this admission.

It is the responsibility of the acute dietetic team to provide a suitable feeding regimen prior to the patient being discharged home.
If the patient is admitted into secondary care and the feeding regimen is changed, it is the responsibility of the acute dietetic team to make the necessary feed and/or ancillary changes with Homeward, so that the patient receives the appropriate feed and equipment on discharge from hospital.

It is anticipated that the patient will require home enteral tube feeding for 4 weeks or longer.

The referrer is confident that after appropriate training, the patient or carer will be able to safely and independently manage the patient’s feeding tube and feed.
The Nutricia Nurse is responsible for training the patient and, if appropriate, carers, on the safe and appropriate use of the enteral feeding pump and ancillary items. It is the responsibility of the discharging Trust to arrange the appropriate training by the Nutricia Nurse for the patient and their carers.

The patient is established on a suitable enteral feeding regimen. The service may not accept dietetic care of a patient whose initial home regimen does not closely mirror their hospital feeding regimen. This includes considering fibre content and method of delivery. Such patient’s dietetic care must be discussed and agreed on an individual basis. Patients with very complex needs, where it is necessary to alter the feeding regimen on a weekly basis, may not be accepted into the service. It may be necessary to have shared care with the referring acute dietetic service. These patients should be discussed with the Somerset Home Enteral Tube Feeding Service prior to the patient being discharged home.

The minimum requirement for a patient to self-manage a feeding tube is that they must have the ability to switch off the pump if it alarms, and be able to flush the tube if they are alone at home.
If this is not possible, a suitable care package, for example involvement of community nurses, should be arranged in advance by the referring team prior to discharge. If a patient refuses input then the Somerset Home Enteral Feeding Team may not accept that patient into the service.

Tube changes should not be anticipated to be more than once per week.
An alternative person to re-pass the tube (e.g. parent/ carer/ community nurse) should be identified and receive appropriate training prior to discharge if the patient is fed via a naso-gastric feeding tube, and tube changes are anticipated to be more than once a week.

The patient should not be deemed at risk of re-feeding syndrome.
Any patient deemed to be at risk of re-feeding syndrome will need to be hospitalised to commence tube feeding and will not be accepted by the Somerset Home Enteral Tube Feeding Service until they are stabilised on their feeding regimen.  This is of particular consideration with day case gastrostomy placements. (Refer to 'Enteral Feeding Policy', Re-feeding Syndrome Guidelines, on the Policies and Procedures page under 'Clinical').