Home enteral nutrition: for individuals and their carers

People may need HEN for many different reasons. For example, a person may:

• not be able to eat or drink enough to meet their nutritional needs through their diet alone
• have swallowing problems after a stroke or because of treatment for head and neck cancer
• have a physical or intellectual disability and have difficulty eating or drinking
• not be able to absorb enough nutrition from their food and drinks due to bowel disease or surgery.

• Your doctor will be able to tell you if you need nutrition support at home (HEN).
• Your dietitian helps you work out what food, drink or nutrition formula you need to stay healthy and can order nutritional drinks, formula and some HEN equipment (for example feeding sets and pumps) for you.
• Speech pathologist assesses your swallowing for food and drinks. If you are unable to swallow some foods safely the speech pathologist can order thickened fluids or thickening powder.
• Registered nurse helps you look after your feeding tube and can order HEN equipment (for example feeding tubes) for you.

People who need HEN may be able to obtain their HEN products at lower prices, delivered to their home.

Some HEN products can be purchased at a chemist.

More about accessing HEN formula and equipment

These are some tips to deal with common HEN issues.

Constipation

• Increase the amount of water you have or give at each feed. Spread it evenly over the total number of feeds.
• Talk to your doctor about your constipation. They may recommend a mild laxative.

Diarrhoea

• Give the feed more slowly. This will allow more time for the feed to be absorbed.
• Make sure you wash your hands before and after handling the feeds and store the formula as recommended by your nutritional health professional.
• Ask your doctor if you are taking any medications which might make the diarrhoea worse.

Dehydration

Dehydration can happen if there is ongoing diarrhoea and/or vomiting, a fever lasting longer than 24 hours, not taking enough fluid or taking diuretic medication.

Seek medical advice if you have any signs of dehydration, such as dry or cracked lips and/or mouth, weight loss, fever, headache or decreased urine output.

Stomach discomfort

Stomach discomfort includes nausea, vomiting, bloating, belching or heartburn.

• Give the feed a little slower.
• Sit up at greater than 30°angle while feeding and for 30 minutes after the feed.
• If vomiting continues, stop the feed and seek medical advice.

Organisations which support consumers using HEN.

• The Oley Foundation
  A non-profit home nutrition therapy member group, based in the United States. Provides information for people with home intravenous nutrition or tube feeding.
• Patients on Intravenous and Nasogastric Nutrition Treatment (PINNT)
  A member organisation based in the United Kingdom. Provides resources and education.

Bolus feed – A set volume of formula given at the same rate as normal drinking.

Continuous feed – A set volume of formula given over a number of hours.

Enteral nutrition – Any form of nutrition which uses the stomach or small bowel.

Gastrostomy tube (or G-tube) – A tube or a low-profile device which is inserted through the skin into the stomach.

Gravity feed – A set volume of formula given through a feeding set using gravity or syringe.

Hyper-granulation – Overgrowth of tissue around the site of the gastrostomy or jejunal tube.

Jejunal tube (or J-tube) – A tube inserted directly into the small bowel.

Nasogastric tube – A tube inserted through the nose into the stomach.

Nasojejunal tube – A tube inserted through the nose into the small bowel.

Nutrition support health professional – The healthcare person who helps you manage your HEN, e.g. dietitian, nurse, etc.

PEG (percutaneous endoscopic gastrostromy) – A procedure to insert a gastrostomy tube.