Between probes and silences: the risk of terminological inconsistency in enteral nutrition

Entre sondas y silencios: el riesgo de inconsistencia terminológica en nutrición enteral

ABSTRACT

Objectives:  to critically reflect on the terminological errors associated with enteral access in Brazil and propose a standardization aligned with national and international guidelines.

Methods:  a reflective essay based on the authors’ expertise, linguistic and conceptual analysis applied to terms used in clinical practice, and a narrative review of national and international guidelines on enteral access.

Results:  imprecise use of acronyms and terms, such as “NGT”, “NET”, and “enteral catheter”, is observed, compromising clinical reasoning, interprofessional communication, and patient safety. The proposed standardization includes anatomical, functional, and clinical criteria to standardize the nomenclature.

Conclusions:  accurate terminology strengthens nurses’ clinical reasoning, supports safe practices, and guides more assertive records. Adopting the suggested standardization can improve protocols, reduce care risks, and promote patient safety.

Descriptors:
Nutrition, Enteral; Tube Feeding; Intubation, Gastrointestinal; Terminology; Patient Safety

RESUMO

Objetivos:  refletir criticamente sobre os equívocos terminológicos associados aos acessos enterais no Brasil e propor uma padronização alinhada às diretrizes nacionais e internacionais.

Métodos:  ensaio reflexivo fundamentado na expertise das autoras, na análise linguística e conceitual aplicada aos termos empregados na prática clínica, e em revisão narrativa de diretrizes nacionais e internacionais sobre acesso enteral.

Resultados:  observou-se uso impreciso de siglas e termos, como “SNG”, “SNE” e “cateter enteral”, que compromete o raciocínio clínico, a comunicação interprofissional e a segurança do paciente. A proposta de padronização apresentada contempla critérios anatômicos, funcionais e clínicos para uniformizar a nomenclatura.

Conclusões:  a terminologia precisa fortalece o raciocínio clínico de enfermeiros, sustenta práticas seguras e orienta registros mais assertivos. A adoção da padronização sugerida pode qualificar protocolos, reduzir riscos assistenciais e favorecer a segurança do paciente.

Descritores:
Alimentação Enteral; Sondas de Alimentação Enteral; Sondas de Nutrição Enteral; Terminologia; Segurança do Paciente

RESUMEN

Objetivos:  reflexionar críticamente sobre los conceptos erróneos terminológicos asociados con el acceso enteral en Brasil y proponer una estandarización acorde con las directrices nacionales e internacionales.

Métodos:  este ensayo reflexivo se basa en la experiencia de los autores, el análisis lingüístico y conceptual aplicado a los términos utilizados en la práctica clínica, y una revisión narrativa de las directrices nacionales e internacionales sobre acceso enteral.

Resultados:  se observó un uso impreciso de acrónimos y términos como “SNG”, “SNE” y “catéter enteral”, lo que compromete el razonamiento clínico, la comunicación interprofesional y la seguridad del paciente. La estandarización propuesta incluye criterios anatómicos, funcionales y clínicos para estandarizar la nomenclatura.

Conclusiones:  una terminología precisa fortalece el razonamiento clínico de las enfermeras, promueve prácticas seguras y facilita la elaboración de registros más asertivos. Adoptar la estandarización sugerida puede mejorar los protocolos, reducir los riesgos asistenciales y promover la seguridad del paciente.

Descriptores:
Alimentación Enteral; Alimentación por Sonda; Nutrición Enteral; Terminología; Seguridad del Paciente

INTRODUCTION

When a technical term is misunderstood, the risk is not just conceptual—it is clinical. In everyday healthcare settings, imprecise use of terms compromises communication among professionals, exposing patients to the risk of mismanagement, which can potentially trigger serious adverse events(¹). This risk is intensified by the lack of terminological consensus, which is not a merely semantic problem, but a concrete obstacle to patient safety and quality of care(²).

Between the silences of healthcare routines and the naturalization of the incorrect use of acronyms and terms like “NGT”, “NET”, and “enteral catheter”, a healthcare vulnerability scenario is created. This fragility can be illustrated by the reasoning applied to medication preparation and administration, in which it is recommended to differentiate letters when names have similar appearance or sound(³). Similarly, there is a similarity in spelling and pronunciation between terms such as “enteral catheter” and “central catheter”.

This essay aims to shed light on this scenario and offer a proposal for terminological standardization adapted to the Brazilian context, in line with national and international guidelines. The term “silence” in the title, in turn, refers to the invisibility and lack of critical questioning of these inconsistencies, highlighting a little-discussed problem that compromises healthcare safety.

Enteral nutrition therapy (ENT) is an essential therapeutic intervention for patients who are unable to maintain adequate oral intake, aiming to maintain or restore nutritional status. It is commonly used in hospitals, homes, and long-term care facilities(⁴). Enteral nutrition (EN) is defined as special food, for use through tubes or orally, industrialized or not, exclusively or complementary, according to patients’ nutritional needs(⁵).

Despite its clinical importance and benefits observed in different settings(⁶), there is still inconsistency in the terminology used in Brazil to designate the devices involved in EN administration. This occurs mainly with short-term devices, although there are cases in which their use extends for years.

In Brazilian clinical practice, terms such as “enteral tube”, “nasogastric tube”, and “nasoenteral tube” are often used interchangeably, without considering the probe tip anatomical location or its actual clinical indication. This inaccuracy is compounded by a misleading association between acronyms and tube types. “NGT”, for instance, is commonly used to designate large-bore tubes made of polyvinyl chloride (PVC) used for gastric drainage, lavage, or decompression. The acronym “NET” is associated with thin polyurethane or silicone tubes, with or without guidewires, used for EN placed in the stomach or small intestine. However, these tubes, even when positioned in the stomach, are routinely classified as “NET”, which leads to errors in interpretation and conduct. This lack of standardization can compromise patient safety by hindering communication among healthcare team members, promoting incorrect management, and increasing the risk of adverse events such as bronchoaspiration(⁷).

In the absence of a widespread national consensus, healthcare institutions and professionals adopt different terms, often based on local traditions or unsubstantiated protocols.

This lack of uniformity compromises clinical reasoning and practice, especially among multidisciplinary teams, and hinders the training of students and residents. Adopting a standardized nomenclature based on recognized guidelines is essential to ensure efficient communication among healthcare professionals, strengthen patient safety, and improve clinical outcomes.

Despite the international relevance of the topic, this essay is limited to the Brazilian context, due to the lack of national normative consensus, the terminological diversity used locally and the urgent need for alignment with international guidelines for qualifying clinical practice in the country.

OBJECTIVES

To critically reflect on the terminological errors associated with enteral access in Brazil and propose a standardization aligned with national and international guidelines.

METHODS

This is a reflective essay based on the authors’ expertise and the American Society for Parenteral and Enteral Nutrition (ASPEN)(⁴) and the Brazilian Society of Parenteral and Enteral Nutrition (In Portuguese, Sociedade Brasileira de Nutrição Parenteral e Enteral - SBNPE/BRASPEN)(⁸) guidelines. The text construction involved a critical analysis of these guidelines aligned with a linguistic approach based on the etymological investigation of the main terms used to designate enteral accesses, with the aim of clarifying their original meanings and their application in clinical practice.

Although the study aligns with conceptual analysis assumptions, such as those proposed by Walker and Avant(⁹), a more flexible and applied methodological approach was chosen, avoiding rigid adherence to classical models. The reflection developed was based on the articulation between the conceptual elements present in the guidelines and the linguistic meanings of the terms used in Brazilian clinical practice, with a focus on semantic clarity, care applicability, and patient safety.

The narrative review of the guidelines was conducted based on the following criteria: (i) acknowledgment of institutions as national or international references in nutritional therapy; (ii) publication in official sources and public access; and (iii) applicability of recommendations to the reality of healthcare practice in Brazil. The selection of ASPEN and SBNPE/BRASPEN is justified by their technical authority and the comprehensiveness of their guidelines regarding the nomenclature, indications, and classifications of enteral devices.

DISCUSSIONS ARISING FROM REFLECTION

Standardizing terminology and classifications related to enteral access is essential to ensure proper device management and their correct clinical indication through clear and effective communication among healthcare professionals. In this context, contributions from leading international (ASPEN(⁴)) and Brazilian (BRASPEN) scientific societies stand out(⁸).

ASPEN is a North American scientific society that brings together healthcare professionals involved in the nutritional care of patients with varying degrees of complexity. Founded in 1975, its mission is to “improve nutritional therapy through science, education, and clinical practice”. It is widely recognized for its evidence-based clinical guidelines and its role in defining safe practices in EN and parenteral nutrition.

BRASPEN, also founded in 1975, is the leading Brazilian organization dedicated to the study and promotion of specialized nutritional therapy. Its mission is to “contribute to the advancement of parenteral and enteral nutrition through professional training, knowledge dissemination, and research promotion”. It serves as a national reference in developing protocols and best practice guidelines for clinical nutrition, including specific recommendations on enteral access nomenclature, indications, and safety.

Both entities classify enteral accesses based on the duration of use and the anatomical location of the distal end of the tube. Short-term devices are those used for up to four to six weeks, such as nasogastric, nasoenteric, nasojejunal, orogastric, and oroenteric tubes. Long-term tubes, such as surgical or percutaneous endoscopic gastrostomy and jejunostomy, are indicated when the need for prolonged EN is anticipated(⁴,⁸).

Distinguishing between these devices is essential to guide appropriate clinical management, including the choice of feeding type, administration method, aspiration risks, nursing care, and monitoring method. Guidelines also emphasize the importance of correctly naming the device based on its functional anatomy, and not solely on characteristics such as material or insertion technique. However, in Brazilian clinical practice, there is a tendency to classify tubes based on criteria such as gauge or material type (PVC, silicone, polyurethane), which contributes to terminological inaccuracies. Furthermore, the “NET” acronym is widely used generically to designate feeding tubes, regardless of their purpose or the tip anatomical location, which contradicts international(⁴) and national recommendations(⁸).

Given the multiplicity of terms used in Brazil to refer to enteral accesses—often applied imprecisely or interchangeably—it is urgent to revisit the conceptual and linguistic foundations that underpin their nomenclature. To advance the proposed terminological standardization in the country, it is necessary to accurately understand the concepts involved, their clinical indications, insertion routes and probe tip positioning, as well as the etymological origins of the terms used.

We present below a conceptual and linguistic analysis of the main terms related to enteral access, with the aim of supporting a proposal for terminological standardization aligned with good practices and guidelines governing ENT.

Beyond the acronym: understanding the terms and concepts of enteral access

Enteral accesses are defined as devices used in clinical practice to administer nutrients, medications and/or hydration directly into the gastrointestinal tract, bypassing the conventional oral route(⁴,⁸). This group includes probes, tubes, and stomas, which can be inserted nasally, orally or directly into the stomach or small intestine, depending on patients’ clinical condition(⁴,⁸). Additionally, accessory devices refer to the supplies that enable this administration, such as bottles, equipment, infusion pumps, extenders, and connectors.

This essay focuses on enteral access, with an emphasis on the terminology associated with short-term feeding tubes, whose inadequate nomenclature has generated significant implications for clinical communication and patient safety.

To deepen the conceptual understanding of these devices and promote accurate terminology, Chart 1 presents an analysis of the main terms related to enteral access, along with their etymological origins and literal meanings. This is a complementary resource to the proposed discussion, aimed at establishing the basis for terminological standardization.

Chart 1
Etymological origin of terms related to enteral access, Brazil, 2025

Term	Origin
Catheter	The word catheter comes from the Greek katheter (kathetér). This is a medical term for a tubular instrument inserted into channels, vessels, or body cavities to remove or inject fluids or substances, or to distend a passageway or conduit, perform diagnostic investigations, etc., or also as a probe, especially one used to remove urine from the bladder.
Enteral	It comes from the Greek énteron (ἔντερον) = “intestine” + the Latin suffix -al, which indicates relationship, i.e., “relating to the intestine”. The term is used to refer to a pathway or device that leads to the gastrointestinal tract.
Enteric	The term originates from the Greek énteron (ἔντερον), meaning “intestine”, associated with the Latin suffix -icus, which forms adjectives with the meaning “relating to”. Thus, enteric literally means “relating to the intestine”. In the clinical context, it is widely used to designate substances, medications, or devices intended for the intestinal tract, as in the terms “enteral nutrition” or “enteric coating”.
Stoma	From the Greek stóma, meaning “opening” or “mouth”. In clinical practice, the term is used to refer to a permanent artificial opening in the abdominal wall, used in certain surgical procedures, such as gastrostomy and ileostomy.
Gastric	It originates from the Greek gastḗr (gastēr, -stros), which means “stomach”, with the addition of the suffix -ico (forming adjectives), influenced by the French gastrique.
Jejunal	The word comes from jejunum, which comes from the Latin jejunus, meaning “empty”, “fasting”. The suffix -al comes from the Latin -alis, indicating relationship or belonging.
Naso	The term is commonly used as a prefix in medical terminology, especially when describing enteral access. It originates from the Latin nasus, meaning “nose”, and indicates that something is related to the nose or that begins through this anatomical route. In clinical practice, this prefix is used when access is via the nose, as in the terms nasogastric, which designates a tube that runs from the nose to the stomach, and nasoenteric, which refers to a tube that runs from the nose to the intestine.
Oro	The prefix oro- comes from the Latin os, oris, meaning “mouth”. It is used to indicate a relationship with the oral cavity, especially in an anatomical and clinical context. Terms such as orogastric, which refers to the tube that runs from the mouth to the stomach, and oroenteric, which indicates the tube that runs from the mouth to the intestine, exemplify the use of this prefix in describing enteral access.
Probe	The word probe originates from the Vulgar Latin “subunda”: from sub- (“under”, “below”) + a derivative of unda (“wave”, “moving water”), indicating something that penetrates or enters liquids or cavities. The word also possibly derives from Old French, from the verb “sonder”, meaning “to probe”, “to measure depth”. From French, it passed into Portuguese as probe, meaning an instrument used to explore or examine internal or deep spaces. In medicine and nursing, the term “probe” is used to refer to devices inserted into the body for diagnostic or treatment purposes.

An etymological analysis of the main terms related to enteral access reveals that the nomenclature used in clinical practice often presents imprecise meanings, often disconnected from anatomical and functional aspects. The correct use of these terms contributes to safe communication among healthcare professionals, guiding informed clinical decisions, especially by nurses, regarding diagnostic assessment, care planning, therapeutic planning, and adequate recording of interventions.

In nursing, terminological accuracy strengthens clinical reasoning, supports evidence-based practices, and promotes patient safety at all levels of care. However, the inappropriate use of certain terms, such as the term “catheter”, which is appropriate in the context of parenteral nutrition therapy, when used inappropriately in reference to EN, can generate conceptual confusion and compromise the accuracy of clinical procedures, as discussed below.

The use of the term “catheter” and the risk of its inappropriate application in enteral nutrition therapy

Although widely used in some clinical and educational contexts, including in the Nursing Interventions Classification, in intervention 1056 (Enteral feeding by catheter(¹¹)), the term “catheter” is not recommended to designate enteral access in the Brazilian context. This is a complex therapy that requires safe and compatible connections. Therefore, in the nursing guideline published by SBNPE/BRASPEN, the authors emphasized that the term “catheter” should be reserved exclusively for vascular accesses(⁸).

Etymologically, the word “catheter” derives from the Greek kathetḗr (καθετήρ), which means “something that descends or is inserted”, originating from kathíēmi (καθίημι), “to let fall” or “to introduce”(¹⁰). In late Latin, the term was incorporated as catheter, retaining the meaning of a tubular instrument inserted into body cavities for drainage, infusion, or measurement (Chart 1). Historically, its use has been associated with vascular, urinary, or intracavitary catheters, which explains the concern about its inappropriate use in EN. Aware of the risks of accidental connections, especially in patients with multiple invasive accesses, SBNPE/BRASPEN recommends the exclusive use of the terms “probe” or “tube” for short- and long-term EN devices(⁸).

When it comes to the terms “nasogastric tube”, “nasoenteric tube”, and “nasojejunal tube”, it is crucial to maintain precision and clarity in clinical communication. While they all refer to tubes inserted through the nose that reach different parts of the digestive tract, there are significant distinctions between them. “Nasogastric tube” is a generic term used to designate tubes that reach the stomach; “nasoenteric tube”, in turn, refers to tubes that reach the small intestine, potentially ending in the duodenum or jejunum. It is indicated in situations where gastric feeding is not feasible or safe, such as in cases of risk of aspiration or gastroparesis.

A nasojejunal tube, on the other hand, is a more specific term, reserved for devices whose distal end is positioned directly in the jejunum, the second portion of the small intestine. It is particularly recommended in cases of severe acute pancreatitis, in which gastric feeding can stimulate the pancreas and worsen the clinical condition. It is also indicated when there is a need to completely bypass the stomach, allowing EN administration via the post-pyloric route.

Therefore, the choice between different terms should consider the exact location of the probe tip and patients’ clinical condition. Using precise terminology, such as “nasojejunal tube”, when the tip is effectively positioned in the jejunum, contributes to safe communication among healthcare professionals, promotes proper management, and reduces the risk of errors in administering nutrition, medication, and hydration. Therefore, it is recommended that the terminology adopted accurately reflects the anatomical position of the device, promoting the safety and efficiency of healthcare practices.

For safety and clarity: standardization of terms related to enteral access

International guidelines, including those from ASPEN(⁴), in the United States, and the European Society for Clinical Nutrition and Metabolism (ESPEN)(¹²), in Europe, present consolidated efforts to standardize EN and enteral access terminology. ASPEN defines terms such as “enteral access device”, “enteral formula”, and “enteral access” in detail, increasing clinical communication accuracy and reducing errors associated with misuse of acronyms and classifications. In Europe, ESPEN has dedicated specific sections in its guidelines(¹²) to clarify the use of terms such as “tube feeding” and “enteral nutrition”, strengthening consensus through continuous updates.

Despite this, there is no clear confirmation of homogeneous terminological standardization across countries, revealing that variations in practice persist. While Brazil lacks a formal consensus integrated with international guidelines, ASPEN(⁴) and ESPEN(¹²) models show that well-defined standards are possible and effectively adopted, serving as a valuable reference for local standardization. Thus, this essay contributes by mobilizing these already internationally structured guidelines to promote contextualized adaptation to the Brazilian reality.

Based on a critical analysis of ASPEN(⁴) and BRASPEN(⁸) guidelines, as well as the evidence discussed throughout this essay, we proposed a terminological standardization for enteral access based on anatomical, functional, and clinical criteria. The proposal seeks to eliminate linguistic ambiguities still common in Brazilian clinical practice, improving communication among healthcare professionals and strengthening patient safety in EN settings.

Chart 2 presents a summary of suggested terminology recommendations, organized according to the appropriate term, manufacturing material, insertion route, probe tip anatomical location and main clinical indications.

Chart 2
Reference framework for standardization of terms related to enteral access, Brazil, 2025

Recommended term	Material	Insertion route	Tip position	Clinical indication
Short-term enteral tubes
Nasogastric (or orogastric) tube	PVC	Nose (or mouth)	Stomach	Gastric drainage, lavage, or decompression.
Nasogastric (or orogastric) tube	Polyurethane or silicone	Nose (or mouth)	Stomach	Feeding, medication administration, and hydration are recommended for patients with a functional stomach.
Nasoenteric (or oroenteric) probe	Polyurethane or silicone	Nose (or mouth)	Duodenum or jejunum	Feeding, medication administration, and hydration are recommended for cases of pyloric obstruction, severe gastroparesis, or a history of reflux.
Nasojejunal probe	Polyurethane or silicone	Nose	Jejunum	Feeding, medication administration, and hydration are recommended for patients with severe acute pancreatitis.
Nasogastrojejunal probe	Polyurethane composed of three ports (gastric, jejunal, and gastric decompression valve)	Nose	Stomach or jejunum	Feeding, medication administration, and hydration (jejunal route). Drainage (gastric route). Are recommended for patients with severe acute pancreatitis or gastroparesis.
Long-term enteral tubes
Gastrostomy	Silicone or polyurethane	Abdominal	Stomach	Feeding, medication administration, and hydration. Need for long-term EN and also when oral/nasal administration is not possible.
Gastrojejunostomy	Silicone or polyurethane composed of three routes (gastric, jejunal and balloon)	Abdominal	Jejunum	Feeding, medication administration, and hydration (Jejunal route). Drainage (Gastric route). Indicated for patients with severe acute pancreatitis or gastroparesis.
Jejunostomy	Silicone or polyurethane	Abdominal	Jejunum	Feeding, medication administration and hydration, when gastric feeding is not tolerated.

This proposed terminology standardization represents an important step forward in improving clinical practice in EN in Brazil. By aligning the nomenclature with criteria of probe tip anatomical location, insertion route, and clinical indication, a common foundation is established that favors effective communication among healthcare professionals, strengthening the culture of patient safety. In addition to minimizing the risk of adverse events resulting from inadequate interpretation of records and incorrect device handling, the consistent use of these terms contributes to the development of more accurate institutional protocols, educational materials, and clinical records, promoting safer care aligned with healthcare practices.

In this regard, the authors of this reflective essay highlight the importance of systematically recording in patients’ medical records: (i) correct nomenclature of the device based on tip location (e.g., nasogastric tube, nasoenteric tube); (ii) the purpose of enteral access (drainage or feeding); (iii) insertion route (nasal or oral); (iv) the method used to verify positioning; (v) insertion date, with a view to traceability and periodic reassessment; and (vi) the name and registration of the professional in charge of the procedure.

Given the naturalization of inconsistent terminology in clinical records and care routines, this essay sheds light on the invisibility that permeates this problem. Amid ambiguous acronyms and imprecise terms, risks emerge that go beyond the realm of language and directly affect care safety and effectiveness. The proposal presented here seeks to break this silence, promoting a standardization that values clarity, precision, and safety—fundamental principles for ethical, qualified, and person-centered nursing practice. It is hoped that, amidst the silences, responsible and well-communicated care will prevail.

Study limitations

Since this is a reflective essay, this study does not include empirical validation of the proposed terminology standardization, nor does it allow for generalization of its findings. The recommendations formulated are based on nationally and internationally recognized guidelines, the authors’ experience, and the conceptual and etymological analysis of terms used in clinical practice. However, no field studies or technical consensus processes with experts were conducted to consolidate the proposal at the national level. Furthermore, the diversity of institutional and regional realities in Brazil may require adaptations or complementary strategies for its effective implementation.

Contributions to health, nursing or public policy

This essay offers relevant theoretical and practical insights for the clinical, educational, and managerial fields of nursing by proposing a standardized terminology for enteral access systems. By clarifying the meaning and appropriate use of terms employed in practice, this study contributes to improving professional communication, enhancing understanding of devices, strengthening patient safety, and guiding more accurate clinical records.

Furthermore, it provides a solid conceptual foundation for developing institutional protocols and teaching materials, fostering the critical and safe training of nurses in the care of patients using ENT. By addressing the inappropriate use of terms like “catheter”, the essay reinforces nursing’s strategic role as a transformative agent of clinical practices toward safety and evidence-based standardization.

CONCLUSIONS

Inconsistent terminology related to enteral access in Brazil compromises the quality of care and exposes patients to avoidable risks. Adopting a standardized nomenclature, based on nationally and internationally recognized guidelines, is essential to ensure efficient communication among healthcare professionals, strengthen patient safety, and improve clinical outcomes.

Nurses play a central role in this process, providing direct care, health education, and developing safe, evidence-based institutional protocols. In addition to using appropriate terminology, nursing records should include essential information such as the probe tip anatomical location, the device’s purpose (feeding or drainage), insertion route, the method for verifying positioning, insertion date, and the nurse’s name and professional association registration number—essential elements for ensuring traceability and periodic reassessment of enteral access.

AVAILABILITY OF DATA AND MATERIAL

The research data are available within the article.

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Edited by

• EDITOR IN CHIEF
  Antonio José de Almeida Filho

• ASSOCIATE EDITOR
  Márcia Ferreira

Publication Dates

• Publication in this collection
  27 Feb 2026
• Date of issue
  2026

History

• Received
  19 May 2025
• Accepted
  24 Aug 2025