Home Enteral Nutrition Service (HENS)

What is Home Enteral Nutrition Service?

Home Enteral Nutrition Service (HENS) provides the clinical and practical support needed for people who cannot meet their nutritional needs by mouth alone. Using specialised feeding tubes (e.g., nasogastric, gastrostomy, jejunostomy) and nutritionally complete formulas, HENS enables patients to receive safe, balanced nutrition in the comfort of their own homes.

Beyond the tube and formulas, HENS coordinates:

• Initial assessment and prescription
• Training for patients, families and carers
• Regular monitoring of nutritional status and tube integrity
• Supply and delivery of feeds, equipment and consumables
• 24hour clinical advice line

Who Can Benefit?

HENS is appropriate for a wide range of clinical conditions, including:

• Neurological disorders stroke, Parkinsons disease, multiple sclerosis, amyotrophic lateral sclerosis.
• Head and neck cancers after surgery or radiotherapy.
• Gastrointestinal diseases inflammatory bowel disease, short bowel syndrome, chronic pancreatitis.
• Severe malnutrition in the elderly or frail patients.
• Patients with chronic obstructive pulmonary disease (COPD) who need highenergy nutrition to wean from ventilators.

Eligibility is determined by a registered dietitian or physician after reviewing medical history, current nutrition status, and the patients ability to manage or receive support for the feeding regimen.

How the Service Works

1. Referral & Initial Assessment

The process usually begins with a referral from a GP, hospital team, or community health professional. A dietitian conducts a comprehensive assessment, which includes:

• Anthropometric measurements (weight, BMI, midarm circumference)
• Biochemical data (albumin, electrolytes, glucose)
• Dietary intake review
• Functional status and goals of care

2. Choosing the Right Feeding Method

Selection depends on prognosis, anatomy, and lifestyle. Options include:

• Nasogastric (NG) tube shortterm (up to 46 weeks)
• Percutaneous endoscopic gastrostomy (PEG) medium to longterm
• Jejunostomy (PEJ) when gastric feeding is not tolerated

3. Prescription of Formula

Formulas are tailored to energy, protein, fluid, vitamin and mineral requirements. Choices include standard polymeric feeds, diseasespecific feeds (e.g., highprotein, renal, diabetic), and fibreenriched or peptidebased formulas for intolerance.

4. Training & Education

Patients and carers receive handson training covering:

• Hand hygiene and infection control
• Tube placement verification
• Connecting and disconnecting feeds
• Troubleshooting (clogging, leakage, accidental removal)
• Recognising warning signs pain, redness, fever, sudden vomiting

5. Ongoing Monitoring

Regular home visits or telephone reviews are scheduled at:

• 1 week postplacement
• 4 weeks
• Every 3 months thereafter, or sooner if problems arise

During these checks, the team assesses weight change, tube site condition, feed tolerance, and updates the prescription as needed.

The Multidisciplinary Team

Effective HENS delivery relies on collaboration among several professionals:

• Dietitian assesses nutritional needs, selects formula, monitors progress.
• Enteral nurse specialist provides technical training, manages complications, liaises with pharmacies.
• Physician (GP or gastroenterologist) authorises the feeding plan, reviews medical issues.
• Pharmacist ensures correct formula preparation, checks drugfeed interactions.
• Speechlanguage therapist evaluates swallowing function and advises on safe oral intake when appropriate.
• Social worker assists with equipment funding, arranging homecare support.

Each member contributes to a personalised care plan, aiming to minimise hospital admissions and maximise patient independence.

Resources & Support

Living with a feeding tube can feel overwhelming, but a wealth of resources is available:

• Patient Education Booklets simple stepbystep guides with pictures.
• Online Video Library demonstrations of tube care, pump setup, and troubleshooting.
• 24Hour Clinical Helpline speak with an enteral nutrition nurse any time.
• Support Groups local and virtual groups where families share experiences.
• National Guidelines British Society for Gastroenterology (BSG) and European Society for Clinical Nutrition & Metabolism (ESPEN) recommendations.