3.1 Explain techniques for extended feeding

This guide will help you answer 3.1 Explain techniques for extended feeding.

Extended feeding is a term used in health and social care to describe any feeding process that continues for a longer duration or requires special techniques. This often happens when a person cannot eat or drink safely using their mouth. Instead, food and liquids are provided using alternative methods, usually for health or medical reasons.

People might need extended feeding because of illnesses, injury, disability, or problems with swallowing. Extended feeding helps deliver all the nutrients, fluids, and medicines safely.

There are several proven techniques for extended feeding. Healthcare teams select the method based on the individual’s needs. This guide covers these techniques and examples how to provide extended feeding in a safe and respectful way.

Reasons for Extended Feeding

Some people cannot take food or drink by mouth. This may be temporary or long-term. Reasons include:

• Stroke or neurological conditions (such as motor neurone disease)
• Cancer affecting the mouth or throat
• Serious injury or surgery to the face, mouth, or throat
• Swallowing problems (dysphagia)
• Severe developmental disabilities
• Chronic illnesses, such as cerebral palsy

Doctors, nurses, and dietitians work together to decide the best way to support the person’s nutrition and hydration.

Main Extended Feeding Techniques

Extended feeding involves specific methods. The three main techniques are:

• Tube feeding (enteral feeding)
• Parenteral feeding (intravenous feeding)
• Assisted oral feeding with support aids

Each technique suits different needs. Below you will find a clear explanation of each method.

Tube Feeding (Enteral Feeding)

Tube feeding is the most common form of extended feeding when someone cannot eat by mouth but their digestive system works. This technique uses feeding tubes to deliver food, drink, and medicine directly to the stomach or intestine.

There are several types of feeding tubes:

Nasogastric (NG) Tube

A soft tube passes through the nose, down the throat, and into the stomach. NG tubes are suitable for short-term use, usually for a few weeks.

• Often used after surgery, stroke, or during recovery
• The tube is replaced regularly

Orogastric Tube

This works like a nasogastric tube, but the tube enters through the mouth. It is used for babies or when the nose tube is not suitable.

Gastrostomy Tube (PEG/PEJ)

A gastrostomy tube is placed directly into the stomach through the abdominal wall. PEG stands for Percutaneous Endoscopic Gastrostomy. PEJ stands for Percutaneous Endoscopic Jejunostomy. These tubes are used for longer periods, sometimes months or years.

• Used when feeding is needed long-term
• Requires a minor surgical procedure to fit
• The site must be kept very clean

Jejunostomy Tube

A jejunostomy tube is inserted into the small intestine (jejunum) through the abdominal wall. This route avoids the stomach, so it suits people with stomach problems.

• Enables feeding if there is a stomach blockage
• Can be long-term

How Tube Feeding is Done

• Liquid food or formula is given using a syringe or feeding pump connected to the tube
• Medicines and fluids are delivered the same way
• The tube is flushed with water before and after feeding to prevent blockages

Tube feeding needs a strict cleaning, checking, and monitoring routine to avoid infection and blockage.

Risks and Safety Points of Tube Feeding

• All equipment must be cleaned and handled carefully to avoid introducing bacteria
• Tubes should be checked for blockages, leaks, or signs of infection like redness or swelling
• Tube position must be checked to prevent feeding into the lungs by mistake
• Staff should wash their hands and wear gloves as standard practice

Staff should watch for complications such as:

• Vomiting
• Diarrhoea
• Discomfort or pain
• Leakage around the tube site

If any signs of complication appear, inform a senior member of staff or medical professional immediately.

Parenteral Feeding (Intravenous Feeding)

Some people cannot use their digestive tract at all. For these people, nutrition is given straight into a vein. This method is called parenteral feeding or Total Parenteral Nutrition (TPN).

How Parenteral Feeding Works

• Sterile liquid nutrition is made in a hospital pharmacy and contains all necessary nutrients
• A tube called a catheter is placed in a large vein, usually in the chest, arm, or neck
• Food, fluids, and medicines are given by slow drip over several hours
• Strict hygiene is needed to prevent infection

When to Use Parenteral Feeding

• Severe digestive problems or after major surgery
• Severe Crohn’s disease or bowel cancer
• Short gut syndrome, when part of the intestine is missing or not working

Risks and Safety Points for Parenteral Feeding

• High risk of infection, so strict procedure must be followed
• Risk of blood clots from the tube in the vein
• Risk of air bubbles (embolism)
• Fluid and electrolyte levels need careful monitoring

Staff regularly check for signs of infection like redness, pain, swelling, or fever. A high standard of care and regular monitoring are very important.

Assisted Oral Feeding With Support Aids

Some people can eat and drink by mouth but need a great deal of help or special equipment. Assisted oral feeding can be short- or long-term and includes:

• Use of thickened fluids to reduce the risk of choking
• Modified texture diets, such as pureed or soft food
• Special cups, adapted cutlery, or plate guards
• Prompting, encouragement, and supervision

Care staff may need to:

• Feed people slowly and in small amounts
• Help the person maintain the correct posture
• Monitor for signs of swallowing difficulty, like coughing or choking
• Allow plenty of time for meals

Steps to Follow When Using Extended Feeding Techniques

All feeding techniques have important dos and don’ts. Following set procedures helps keep the person safe and maintains their dignity.

Preparation

• Check the person’s care plan and feeding protocol
• Gather all needed equipment, keeping items clean and ready
• Wash hands and use gloves or aprons when needed
• Prepare feeds or liquids as prescribed, following measured instructions

During Feeding

• Always talk to the person and explain what will happen, even if they seem unable to respond
• Check for correct positioning of tubes or aids
• Keep the person sitting upright if possible, or support their head and neck to aid swallowing and comfort
• Watch the person’s facial expression and breathing for signs of distress or discomfort

After Feeding

• Flush feeding tubes with clean water to clear them
• Clean all used equipment
• Document the amount of food, fluids, and medicine given
• Report any problems to the senior team or nurse

Respect and Dignity

Extended feeding can feel strange and sometimes undignified for the person. Help them feel respected by:

• Explaining every step and involving them as much as possible
• Maintaining privacy and avoiding unnecessary exposure
• Giving time for them to ask questions or react
• Always using their preferred name and speaking kindly

Communication and Records

Accurate record-keeping is a legal requirement. After each feed, staff record:

• Type and amount of feed given
• Time of feeding
• Any problems or side effects
• Confirmation of tube position
• Any medication added to feeds

Records help teams monitor nutrition and hydration levels and spot trends or problems.

Family members and the individual themselves should be included in discussions about feeding, feeding choices, and changes to routines when possible.

Infection Prevention and Hygiene

Extended feeding raises infection risk because food is delivered straight to the digestive tract or bloodstream. Follow these key steps:

• Wash hands thoroughly and use gloves for any feeding
• Clean all feeding equipment before and after use, using sterile or single-use items when possible
• Wear aprons if there’s a risk of spills or splashes
• Change dressings around tube sites to keep them clean and dry
• Dispose of waste and used items using clinical waste bins

Signs of infection around a tube or catheter include:

• Redness
• Swelling
• Pain
• Leakage
• Pus
• Fever or illness

If infection is suspected, stop feeding and seek advice immediately.

Position and Comfort

Position makes feeding safer and more comfortable. Tips include:

• Seat the person upright, about 30 to 45 degrees, to prevent choking or reflux
• Support their back, neck, and head
• For tube feeding, keep the person upright for at least 30 minutes after feed
• For bed-bound people, use adjustable beds or extra pillows

Comfort includes:

• Using cushions or supports
• Providing tissues and wipes
• Letting the person call for assistance

Person-Centred Approaches to Extended Feeding

Person-centred care means tailoring feeding routines to individual needs and preferences. This could involve:

• Considering cultural or religious preferences if possible with liquid feeds
• Allowing personal choice in flavour or timing of feeds if safe
• Supporting independence, such as letting someone hold their own adaptive cup
• Listening to feedback about pain, discomfort, or feelings about feeding

Emotional Wellbeing and Support

Being unable to eat in a normal way can be emotionally hard. People may feel left out during meals or sad about missing favourite foods. Support can include:

• Talking to them about their feelings
• Allowing them to take part in meal times socially if possible, even with tube feeding
• Helping families understand reasons for extended feeding
• Encouraging involvement in chosen activities

Professional support and counselling may help if feeding changes are long-term.

Monitoring, Review, and Troubleshooting

Whatever technique is used, regular review is important. Teams monitor:

• Weight, hydration, and nutritional needs
• Tube and site condition
• Signs of problems, such as leaks or infections
• Changes in the individual’s ability to eat or drink by mouth

Reviews support better outcomes and safety, and feeding plans should be adapted as the person’s condition changes.

Problems during extended feeding include:

• Tube blockages
• Dislodged tubes
• Poor fluid intake or dehydration
• Vomiting or diarrhoea
• Sore skin or wound infection
• Medicines left in the tube

Staff should never try to fix these problems alone unless trained and authorised. Report and seek help quickly.

Legal and Ethical Considerations

Extended feeding raises legal and ethical questions. Consent must be gained from the individual if they have capacity. If not, decisions must follow best interests, as outlined in the Mental Capacity Act 2005.

Staff must report concerns about neglect, refusal, or risks around feeding. The person’s wishes should always drive decisions, including when they want to stop or change feeding methods.

Final Thoughts

Extended feeding covers several techniques, including tube feeding, parenteral (intravenous) feeding, and assisted oral feeding with supports. Each method helps people who cannot eat or drink safely by mouth. Staff follow procedure, keep strong records, and work with the person to keep them safe and comfortable. Hygiene, dignity, accurate monitoring, and emotional support are all key parts of extended feeding.

Whenever in doubt, seek help from a trained nurse or senior staff for any questions or concerns during extended feeding. Workers play an important role in upholding high standards, supporting people kindly, and keeping accurate records during all extended feeding.