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

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.