This article is aimed at ward-based clinicians dealing with the everyday issues of enteral tube feeding (ETF). It is therefore intended to be a brief description of the essential clinical information to allow for safe and good practice. The areas covered are:• indications • routes and delivery of feeding • complications.Ethics of nutritional support is another extremely important component and is covered in another article in this series. DefinitionETF is the delivery of nutritionally complete feed directly into the stomach or small intestine via a tube. IndicationsETF is indicated in any patient who cannot meet nutritional requirements by oral intake and who has a functioning and accessible gastrointestinal (GI) tract. It can be administered either into the stomach or directly into the small intestine (usually the jejunum). Table 1 shows examples of when enteral feeding is indicated. RoutesThe possible routes of administration are listed in Table 2. Methods of feeding Nasogastric tubesNasogastric tubes are recommended for patients who require tube feeding for no longer than four to six weeks. This approach is safe, cost-effective and less invasive than gastrostomy. There are two types of NGT:1 Fine-bore tubes, designed for administration of feed. They are usually easy to insert and are safe, even in patients with oesophageal varices. They should not be inserted in patients with obstructive pathology in the nasopharynx or oesophagus or in those with basal skull fractures. 2 Wide-bore tubes (eg Ryles), designed for aspiration. They can cause oesophageal damage such as ulceration and stricture if left in for a prolonged period, and should not normally be used for feeding.It is important that the position of the NGT is correctly checked and confirmed after insertion to reduce the risk of complications. The National Patient Safety Agency (NPSA) recommends that the pH of aspirate (stomach contents) should be less or equal to 5.5. 1 A more alkaline pH may indicate positioning in the bronchial tree. It should also be noted that gastric pH will be elevated by acid-suppressing medications; patients receiving these will require a chest X-ray (CXR) to verify the NGT position. 1 The NPSA also recommends that tube position should be checked before each administration of feed or medication. 1 However, there has to be an element of pragmatism in this: clearly a repeat CXR -even repeated aspirate testing -is unrealistic every time a feed or medication is given.The most commonly encountered problem with NGT is inadvertent removal, either at the hand of the patient or by accident (eg snagged on clothing, vomiting). If this is a recurring problem and feeding is still required, either • Gastric outlet obstruction: mechanical (tumour, pyloric stricture) or functional (stasis) (these situations will require jejunal feeding)• Severe pancreatitis (gastric or jejunal) 617 CME Nutritionpercutaneous endoscopic gastrostomy (PEG) can be considered or a 'nasal loop' or bridle attached, thereby making accidental removal far less likely. In ...