Long-term nasogastric tube feeding under physical restraint: indications for best practice

Author/s
Sarah J. Fuller, Alex Ruck Keene, Jacinta Tan
Citation
Focus Issue 6: Eating disorders
CEPiP.2024.1.257-260
Abstract

Nasogastric tube (NGT) feeding is a common medical intervention used to help malnourished patients meet their nutritional needs. Occasionally this is used to help patients with restrictive eating disorders if they are unable to meet their nutritional requirements through oral diet or supplements when appropriate meal support is given. NGT feeding against a patient’s will, requiring physical interventions to maintain their safety, can be used to stabilise a patient medically in lifesaving scenarios. Recent research highlighted the extent of this practice within mental health wards in England, with 622 patients reported to have received this intervention in a one-year period. The length of time for which this intervention was required ranged from a single feed to 17 patients receiving it for over a year, and one patient for six years. These findings have raised ethical and legal concerns regarding the extent of this restrictive intervention and the associated physical, emotional and psychological risks it carries for the patient, as well as the emotional and psychological risk to the inpatient peer group, parents/carers and the staff involved. This paper aims to suggest the best ethical, legal and clinical practice regarding this intervention for those practicing in England and Wales.

Keywords: nasogastric tube feeding, ethical, legal, physical restraint, restrictive practice, best practice.

Cite as: Cutting Edge Psychiatry in Practice 2025, 6(1):257-260; https://doi.org/10.65031/cpsv5228

References

  1. Royal College of Psychiatrists. CR 233: Medical emergencies in eating disorders (MEED). Guidance on recognition and management 2022. Accessed 23 November 2023. Available from: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/collegereports/college-report-cr233-medical-emergencies-in-eating-disorders-(meed)-guidance.pdf?sfvrsn=2d327483_63. https://doi.org/10.1016/j.clnesp.2023.12.076
  2. National Institute for Health and Care Excellence (NICE). Eating disorders: recognition and treatment. NICE guideline [NG69] 2017. Updated 16 December 2020. Accessed 6 October 2023. Available from: https://www.nice.org.uk/guidance/ng69/chapter/Recommendations#identification-and-assessment. https://doi.org/10.24292/01.mf.0120.14
  3. Kells M, Kelly-Weeder S. Nasogastric tube feeding for individuals with anorexia nervosa: an integrative review. Journal of the American Psychiatric Nurses Association. 2016;22(6):449-68. https://doi.org/10.1177/1078390316657872
  4. Rizzo SM, Douglas JW, Lawrence JC. Enteral nutrition via nasogastric tube for refeeding patients with anorexia nervosa: a systematic review. Nutrition in Clinical Practice. 2019;34(3):359-70. https://doi.org/10.1002/ncp.10187
  5. Hindley K, Fenton C, McIntosh J. A systematic review of enteral feeding by nasogastric tube in young people with eating disorders. Journal of Eating Disorders. 2021;9:1-13. https://doi.org/10.21203/rs.3.rs-121006/v2
  6. Pruccoli J, Pelusi M, Romagnoli G, Parmeggiani A. The impact of nasogastric tube feeding on drive for thinness and body dissatisfaction in children and adolescents with anorexia nervosa. European Psychiatry. 2022;65(S1):S384-S5. https://doi.org/10.1192/j.eurpsy.2022.975
  7. Skills for Care Skills for Health Department of Health. A positive and proactive workforce. A guide to workforce development for commissioners and employers seeking to minimise the use of restrictive practices in social care and health Leeds 2014. Accessed 23 November 2023. Available from: https://www.skillsforcare.org.uk/resources/documents/Developing-your-workforce/Care-topics/Behaviours-which-challenge/A-positive-and-proactive-workforce.pdf. https://doi.org/10.1377/forefront.20230919.435508
  8. Fuller SJ, Tan J, De Costa H, Nicholls D. Nasogastric tube feeding under physical restraint: comprehensive audit and case series across inpatient mental health units in England. BJPsych Bulletin. 2023:1-6. https://doi.org/10.1192/bjb.2023.30
  9. Fuller S, Street O, Hudson L, Nicholls D. Enteral feeding young people with anorexia nervosa under restraint in inpatient settings. British Journal of Mental Health Nursing. 2019;8(3):124-8. https://doi.org/10.12968/bjmh.2019.8.3.124
  10. Fuller S, Philpot U, Group W, Barrett N, Cooper E, Doyle M, et al. The development of consensus‐based guidelines for dietetic practice in nasogastric tube feeding under restraint for patients with anorexia nervosa using a modified Delphi process. Journal of Human Nutrition and Dietetics. 2020;33(3):287-94. https://doi.org/10.1111/jhn.12731
  11. Falcoski P, Philpot U, Tan J, Hudson L, Fuller S. Nasogastric tube feeding in line with new dietetic guidelines for the treatment of anorexia nervosa in a specialist children and adolescent inpatient unit: a case series. Journal of Human Nutrition and Dietetics. 2021;34(1):33-41. https://doi.org/10.1111/jhn.12765
  12. Fuller SJ, Tan J, Nicholls D. Nasogastric tube feeding under restraint: understanding the impact and improving care. BJPsych Bulletin. 2023:1-5. https://doi.org/10.1192/bjb.2023.58
  13. Fuller SJ, Tan J, Nicholls D. Decision-making and best practice when nasogastric tube feeding under restraint: multi-informant qualitative study. BJPsych Open. 2023;9(2):e28. https://doi.org/10.1192/bjo.2022.643