Tube feeding may be the only choice for some patients, and it must always be done cautiously. A variety of imbalances may develop, including dehydration, overhydration, or tube feeding syndrome. Aspiration pneumonia is also a major concern; feeding into the duodenum or jejunum lowers this risk. Tube feeding formulas should be started at a lower strength and increased gradually until the necessary amount and rate is reached. It is important that the rate and strength are not adjusted simultaneously. Checking residual gastric contents is a good rule to help prevent intolerance and aspiration. High residuals may indicate that the patient needs a change in formula, route, method, or rate of feeding [The NCGNP Newsletter. 1990; 26:2,3].