Introduction: Gastroparesis may preclude intragastric feeding during intensive care. Transpyloric delivery of enteral nutrition is a safe and effective alternative to parenteral nutrition. A multidisciplinary team was established in order to review clinical practice in UK paediatric intensive care units with regard to nasojejunal tube (NJT) insertion. We found that attempts at NJT placement were haphazard, delayed, X-ray dependent and often unsuccessful. This reflected practice in our unit where NJT placement was performed by a radiologist using ultra sound screening. We aimed to develop clinical guidelines for bedside NJT placement in children cared for on the paediatric intensive care unit (PICU) and establish a prospective clinical audit. Methods: The literature was reviewed for evidence based clinical guidelines for NJT placement in PICU. A clinical guideline was then developed for local use, drawing on elements from the existing literature. Results: A literature review revealed that there was limited evidence on which to base clinical guidelines for NJT placement. Most guidelines were adult-focused, complex, invasive, often involving drugs, dyes and X-ray positioning; success rates with placement were variable and often low. Our guideline in contrast is simple, user-friendly, and minimally invasive, combining a series of techniques to eliminate the need for drugs or radiological investigation. Following confirmation of gastric placement the NJT is slowly rotated close to the nostril whilst advanceing NJT to the estimated length for jejunal placement. A flow diagram with ’trouble shooting’ section, nursing care plan and audit tool were also produced to enable all nursing and medical (including inexperienced) staff to be able to perform the procedure easily and with safety. 10 NJT have been successfully placed in 8 patients: mean (range) time taken 35 minutes (20–45). No motility agents were used to advance NJT through the pylorus. NJT position was established without the use of X-ray. In 5 patients who had an X-ray for other clinical indications jejunal placement was confirmed. 1 mechanical complication (kinked tube) was reported. Conclusion: A prospective clinical audit, identified the following possible benefits of the new guideline: timely placement of NJT enabling early nutritional support avoidance of the risks posed by radiation, drugs and chemical dyes a reduction in the use of parenteral nutrition and risk of its attendant complications improved patient care and potential cost savings