In Australia, enteral and parenteral feeding are essential medical interventions that support individuals who are unable to meet their nutritional needs through normal eating. These methods are commonly used in a range of health conditions, including neurological disorders, cancer, critical illness, and gastrointestinal complications. Enteral feeding delivers nutrition directly to the stomach or small intestine when the digestive system is still functioning, while parenteral feeding provides nutrients intravenously when the gut cannot be used. For carers, understanding the differences between these feeding methods is vital to ensure safe, effective care. This includes recognising potential complications, following clinical guidelines, and maintaining hygiene to support the health and wellbeing of the person receiving nutritional support.
What is Enteral Feeding?
Enteral feeding involves delivering liquid nutrition, or enteral feeds, directly into the digestive tract using specialised enteral feeding equipment such as feeding tubes and pumps.
Types of Enteral Feeding Tubes
There are three common types of feeding tubes, classified by their insertion site, but all serve the same purpose: ensuring the person receives the appropriate amount of nutrients.
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A Nasogastric (NG) tube is flexible and inserted through the nose, down the oesophagus, and into the stomach. This form of enteral feeding is mostly used for short-term cases.
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A Gastrostomy (G) tube is placed directly into the stomach through the abdominal wall and is used for longer-term feeding.
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A Jejunostomy (J) tube is inserted into the jejunum (part of the small intestine) through the abdominal wall and is used when stomach feeding isn’t possible or when there is a risk of aspiration.
Benefits of Enteral Nutrition
Enteral nutrition offers several important benefits, making it the preferred method of nutritional support when the gastrointestinal system is functional. It helps maintain gut integrity and function, reducing the risk of complications such as gut atrophy and bacterial translocation. Compared to parenteral nutrition, enteral feeding carries a lower risk of infection and supports more natural digestion and nutrient absorption. It is also more cost-effective, which is particularly relevant in the context of Australia’s healthcare system, where managing long-term care sustainably is important. Additionally, enteral feeding supports immune function through the gut’s role in immune defence and is generally easier to manage over the long term, especially for individuals receiving care at home. These advantages contribute to improved health outcomes and a better quality of life for those requiring ongoing nutritional support.
What is Parenteral Feeding?
Parenteral feeding bypasses the digestive system and delivers nutrients directly into the bloodstream via vascular access devices (catheters).
Types of Parenteral Feeding Tubes
There are two main types of parenteral feeding lines: Peripheral Venous Catheters (Peripheral IVs) and Central Venous Catheters (CVCs).
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Peripheral IVs are thin, flexible tubes inserted into small veins in the arm or hand. They are commonly used to administer fluids, medication, and parenteral nutrition for short-term periods, typically around 7 to 10 days.
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CVCs are inserted into larger veins and deliver highly concentrated nutrient solutions. These are preferred for long-term parenteral nutrition and include:
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Tunneled Central Venous Catheters, surgically placed under the skin to reduce infection risk.
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Peripherally Inserted Central Catheters (PICC lines), inserted through a vein in the arm and advanced to a central vein, ideal for intermediate-term use (weeks to months).
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Implanted Ports (Port-a-Cath), devices implanted under the skin connected to a central vein catheter, used for long-term nutrition with lower infection risk.
Benefits of Parenteral Nutrition
Parenteral nutrition is a critical intervention for individuals unable to use their gastrointestinal tract due to serious medical conditions such as bowel obstruction, short bowel syndrome, or severe gastrointestinal disease. It provides a complete, individualised mix of nutrients directly into the bloodstream, bypassing the digestive system entirely. For carers, understanding the principles and requirements of parenteral feeding is essential to ensure safe and effective support. This includes monitoring for signs of infection, managing vascular access devices, and adhering to strict hygiene protocols. With proper education and guidance, carers play a vital role in maintaining the health, comfort, and nutritional stability of individuals receiving parenteral nutrition in both hospital and home settings.
Key Difference Between Enteral and Parenteral Feeding
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Category |
Enteral Feeding |
Parenteral Feeding |
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Use of Digestive System |
Utilises the GI tract, preserving normal gut function |
Bypasses the GI tract; doesn’t support gut integrity |
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Infection Risk |
Lower risk of systemic infection if managed properly |
Higher risk due to central venous catheter use (e.g., sepsis) |
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Cost |
Cost effective, suitable for community and long-term care |
More expensive requiring sterile equipment and clinical monitoring |
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Nutrient Delivery |
Mimics natural digestion and absorption |
Provides precise control over nutrient composition |
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Complications |
Risk of aspiration, tube blockage, or dislodgement |
Risk of line infections, metabolic imbalances, and liver dysfunction |
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Indications |
First-line option if GI tract is functional |
Essential when GI tract is non-functional or unsafe to use |
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Home Use Suitability |
Commonly used at home with carer training |
Possible at home with specialised support and medical oversight |
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Monitoring Requirements |
Requires regular tube care and observation |
Requires intensive monitoring, blood tests, and sterile line care |
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Long-Term Tolerance |
Better tolerated for long-term nutritional support |
Long-term use may lead to liver issues and central line complications |
When to Choose Enteral vs. Parenteral Nutrition
Enteral feeding is typically the first choice when a person is unable to eat by mouth but their gastrointestinal (GI) tract is still functioning. It allows nutrients to be delivered directly into the stomach or small intestine through a feeding tube, supporting natural digestion and gut health. This method is often used for individuals recovering from strokes, living with neurological conditions, undergoing cancer treatment, or experiencing difficulty swallowing. With proper training, carers and parents can manage enteral feeding safely at home (National Institute for Health and Care Excellence (NICE), 2020).
Parenteral feeding is used when the GI tract is not working or cannot be used safely, such as in cases of bowel obstruction, severe Crohn’s disease, or after major gastrointestinal surgery. It involves delivering nutrients directly into the bloodstream through an intravenous line. Parenteral nutrition is essential when the digestive system cannot absorb nutrients effectively and requires careful monitoring to prevent infection and manage complications. In some cases, it can also be administered at home with the support of a specialised medical team (Australian Commission on Safety and Quality in Health Care, 2017).
Common Challenges and Risk Factors
Caregivers supporting individuals on enteral or parenteral feeding need to be aware of several important challenges and risks to ensure safe and effective care.
For enteral feeding, common issues include tube dislodgement or blockage, which can interrupt nutrition delivery and require medical attention, as well as the risk of aspiration pneumonia if feeding contents enter the lungs, especially in those with swallowing difficulties. Skin infections or irritation around the tube site, gastrointestinal problems such as nausea, vomiting, diarrhoea, or constipation, and the psychological impact of tube feeding are also significant concerns.
Parenteral feeding carries higher risks, including infections related to central venous catheters that can lead to bloodstream infections, metabolic complications such as electrolyte imbalances and liver dysfunction, and line-related problems like catheter blockage or thrombosis. Long-term parenteral nutrition may also cause liver damage and bone density loss. Parenteral feeding also requires strict sterile technique and careful monitoring, making adequate carer training essential. With appropriate education and healthcare support, carers can manage these risks effectively and support the health and wellbeing of those in their care.
Conclusion
Enteral and parenteral feeding are vital nutritional support methods that enable individuals with impaired oral intake to maintain their health and wellbeing. For carers and parents, understanding the differences between these feeding types, the appropriate use of enteral feeding equipment, and the potential risks involved is essential to providing safe and effective care.
While enteral feeding is generally preferred due to its support of natural digestive processes and lower complication rates, parenteral feeding remains a life-saving option when the gastrointestinal tract cannot be used. With proper training, ongoing monitoring, and collaboration with healthcare professionals, carers play a crucial role in managing these therapies—helping to improve outcomes and quality of life for those they support in Australia’s healthcare settings.