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Understanding Enteral and Parenteral nutrition: written for patients, following NHS guidelines.
Enteral Nutrition (EN)
Enteral nutrition delivers liquid feed directly into the gut through a tube. It is used when someone cannot eat enough by mouth but their digestive system still works.
Based on BAPEN standards for Home Enteral Nutrition (HEN).
Types of enteral tubes
A fine tube passed through the nose, down the throat, into the stomach. Used short-term (weeks). Must be checked before every feed using pH testing strips.
A tube placed through the abdominal wall into the stomach during an endoscopy (a camera test). Used long-term. Held in place by an internal bumper or balloon.
Delivers feed past the stomach directly into the small intestine (jejunum). Used when the stomach cannot tolerate feed (e.g. gastroparesis).
A discreet button-style device flush with the skin. An extension set is attached for feeds. Balloon devices are usually changed every 4 to 6 months.
Parenteral Nutrition (PN / TPN)
Parenteral nutrition delivers complete nutrition directly into the bloodstream through a central venous line. It bypasses the digestive system entirely.
Total Parenteral Nutrition (TPN) provides all nutrition intravenously. It is used when the gut cannot absorb enough nutrition.
Based on BAPEN standards for Home Parenteral Nutrition (HPN) and NHS England specialised commissioning guidance.
Types of venous access
A tunnelled central venous catheter (CVC) surgically placed under the skin. The external end sits on the chest. It is the most common choice for long-term HPN. Can be single or double lumen.
Inserted through a vein in the arm, threaded to a large central vein. Used medium-term. Requires careful arm care.
A device placed fully under the skin with a small reservoir accessed by a special needle. Very discreet. Requires needle access for each use.
Short-term PN through a peripheral cannula. Limited to lower concentration solutions. Used in hospital or for short-term home support.
What's in a TPN bag?
Your bag is made up to your prescription. Some are compounded to order by a specialist pharmacy; others are ready made bags with separate chambers that are mixed just before use, often with vitamins and trace elements added. Most contain some or all of:
Home monitoring
Your nutrition team decides how often you are checked. NICE guidance (CG32) says monitoring at home should be at least weekly at first, with a specialist clinic review every 3 to 6 months, and more often in the early months or when anything changes.
- Weight, same time and same scales, as often as your team asks
- Temperature, whenever you feel unwell or shivery
- Fluid in and out, if your team asks you to
- Blood tests, as often as your team sets
- Temperature of 38°C or above, or below 36°C
- Weight change of more than 2 kg in a week
- Redness or discharge at line/tube site
- Feeling unwell during or after infusion
Useful organisations
The UK patient charity for people on tube and IV feeding. Peer support, helpline, and events.
Visit PINNT →British Association for Parenteral and Enteral Nutrition, clinical guidelines and standards.
Visit BAPEN →Information about conditions, treatments and NHS services.
Visit NHS.uk →