Lisa Epp, RDN, LD, CNSC · Hurt R, Edakkanambeth Varayil J, Epp L, et al. Blenderized Tube Feeding...
Transcript of Lisa Epp, RDN, LD, CNSC · Hurt R, Edakkanambeth Varayil J, Epp L, et al. Blenderized Tube Feeding...
LisaEpp,RDN,LD,CNSC
DisclosuresIhaveacommercialrelationshipwithNestle,AbbottandHalyardHealthasaconsultant/memberofspeaker’sbureau,etc.andwillprovidepracticerecommendationsthatarebasedonformalstructuredreviewoftheliterature.
Objec.ves! Evaluatewhoisusingblenderizedtubefeeding(BTF).! DefinecriteriathatshouldbemetpriortostartingBTF.
! BeabletolisttoolsneededtomakeandadministerBTF.
! ConstructsamplerecipesforBTF.! Discussdifferencesbetweenthepremadewholefoodformulas.
Whoisblending?
Mayopa.entsblending! AuthorsconductedastudyofMayopatients(54adults).
! BTFwasusedby55.5%ofpatients.! 90%expressedadesiretouseBTFifprovidedwithadequateinformation
! GIsymptoms! 83%hadnosymptomsonBTF! 67%hadnosymptomsoncommercialformula
Results:BTFistoleratedaswellascommercialformulas
HurtRT,EdakkanambethVarayilJ,EppLM,etal.BlenderizedTubeFeedingUseinAdultHomeEnteralNutritionPatients:ACross-SectionalStudy.NutrClinPract.Dec2015;30(6):824-829.
OleyFounda.onSurveyPediatrics(125respondents)
! 89.6%ofpediatricpatientsusedBTF! 71%oftotaldailyintake! 75%usedhomemadeblends! 90.2%reportednoweightlosswhenusingBTFcomparedto58.9%reportedno
weightlosswhenusingcommercialformulasAdults(91respondents)
! 65.9%ofadultpatientsusedBTF! 56%oftotaldailyintake! 67%usedhomemadeblends! 51(85%)reportednoweightlosswhenonBTFvs31(32%)reportingnoweightloss
withcommercialenteralformulas.! Results:usingcommercialENformulawasmorelikelytoleadtoweightlossthanusing
BTF(P<.0001).Epp,L.,Lammert,L.,Vallumsetla,N.,Hurt,R.T.,Mundi,M.S.UseofBlenderizedTubeFeedinginAdultandPediatricHomeEnteralNutritionPatients.NutrClinPractApril2017.
HENDemographicssurvey! OnlinesurveylinkedonOleyFoundationandFeedingTubeAwarenessFoundationonline.
! CoramandPediatricHomeServicesalsohelpedadministerthesurveys.
! 1519surveyscompleted! 1062<18yearsold
! 23.6%reporteduseofBTF
! 457≥18yearsold! 14.9%reporteduseofBTF
AbstractpresentedatASPENNutritionScienceandPracticeConferenceJanuary2018https://www.nutritioncare.org/uploadedFiles/Documents/ASPEN_2018/ASPEN18_Abstracts/WEDNESDAY%20POSTERS%202018.pdf
Takeaway! Manypatientsareblendingandthisshouldbepartofeverynutritionassessmentforanenterallyfedpatient.
! Cliniciansrefusingtoconsidertheseformulasorhomemaderecipesmayleadtopatientharm.
! Somepatientsmaynotbeabletoblendandmayfeel“shame”.
! “muchmoreenergywithblenderizedfeedings®ularbowelmovements”
! “itsgreattohaveflexibilityandchoice”! “FeelthebestIhavein10years”
Criteria! Talktoyourprimarycareprovider! Maturestoma
! 12Frenchorgreatertube! SmallerFrenchsizesmayworkwithsomecommercial
formulasandthinnerhomeblends.
! Someformulasmayworkwithnasaltubes! Determineasystemformonitoring! Nutritionprofessionalavailable
PerceivedbenefitsRDNrapport! 2,448dietitiansresponded! 58%useandrecommendBTF! Mostcommonreasonforusewasparentrequest(70.2%)Parents! 244parentsresponded,50%usingBTFinsomeway
! Onlyhalf(49.3%)ofparentsusingBTFreferredtodietitiansforfeedingoversight
Johnson,TeresaW.;Spurlock,Amy;Pierce,LeahSurveyStudyAssessingAttitudesandExperiencesofPediatricRegisteredDietitiansRegardingBlendedFoodbyGastrostomyTubeFeeding.NutritioninClinicalPractice,Jun2015;30(3):402-405.(4p)JohnsonT,SpurlockA,EppL,etal.ReemergenceofBlendedTubeFeedingandParent’sReportedExperiencesinTheirTubeFedChildren.TheJournalofAlternativeandComplementaryMedicine.November2017,aheadofprint.
ClinicalBenefits! Improvereflux! Decreaseinvomiting! Bowelregularity
! Improveddiarrhea
! Increasedbacterialdiversityofgut! Boweladaptationimproved
PentiukS,O'FlahertyT,SantoroK,WillgingP,KaulA.Pureedbygastrostomytubedietimprovesgaggingandretchinginchildrenwithfundoplication.JPENJParenterEnteralNutr.May2011;35(3):375-379.KolacekS,GrgurićJ,PerclM,etal.Home-mademodulardietversussemi-elementalformulainthetreatmentofchronicdiarrhoeaofinfancy:aprospectiverandomizedtrial.EurJPediatr1996;155:997–1001.ClaessonMJ,JefferyIB,CondeS,etal.Gutmicrobiotacompositioncorrelateswithdietandhealthintheelderly.Nature2012;488:178–84.GallagherK,FlintA,MouzakiM,etal.BlenderizedEnteralNutritionDietStudy:Feasibility,Clinical,andMicrobiomeOutcomesofProvidingBlenderizedFeedsThroughaGastricTubeinaMedicallyComplexPediatricPopulation.JournalofParenteralandEnteralNutrition.January2018SamelaK,MokhaJ,EmerickK,DavidovicsZH.TransitiontoaTubeFeedingFormulaWithRealFoodIngredientsinPediatricPatientsWithIntestinalFailure.NutrClinPract.2016Aug4.pii:0884533616661011.
ClinicalHesita.on! Limitedpublishedpeerreviewedpublications! Microbialcontamination! Variabilityofnutritionalcomposition! Increaseinclinician’stime! Potentialincreaseincost/losereimbursement! Possibletubeclogging,tubewearsoutmorequickly! Maybemoredifficulttotravel! Facilityorhospitalmaynotsupportit
SullivanMM,Sorreda-EsguerraP,SantosEE,etal.BacterialcontaminationofblenderizedwholefoodandcommercialenteraltubefeedingsinthePhilippines.JHospInfect.Dec2001;49(4):268-273VieiraMM,SantosVF,BottoniA,etal.Nutritionalandmicrobiologicalqualityofcommercialandhomemadeblenderizedwholefoodenteraldietsforhome-basedenteralnutritionaltherapyinadults.ClinNutr2016DecJalaliM,SabzghabaeeAM,BadriiSS,etal.Contaminationofhospital-preparedenteraltubefeedingformulasinIsfahan,Iran.JResMedScii2009May-Jun;14(3):149–156.WailaC,VanHoornM,EdlbeckA,etal.TheRegisteredDietitianNutritionist’sguidetohomemadetubefeeding.JAcadNutrDiet.2016;Mar
Toolsneeded
Tools! Blenderstudy
! Blenderstested:OsterBlender,Cuisinartfoodprocessor,MagicBullet,MegaKitchen-NinjaSystemandVitamix.
! Vitamixseemstoblendbetterthanallofthedevices,forthickerrecipes,withtheexceptionoftheMegaKitchen-NinjaSystem.
! Increasedblendingtimehelpedwithlesspowerfulblender! BlendtecworkedaswellasVitamix.
! CathetertipOringsyringes! Don’tgetsticky! Easiertopush! Mayhelptooilsyringes
! Straightbolusextensionsets
Manpreet Mundi, MD; Lisa Epp, RDN; Wanda Duellman, RDN; Jacob Davidson; Satyanarayana Yaramala, MBBS; Steve Corner; Ryan Hurt, MD. Efficiency of Blenders used to Prepare Home Blenderized Tube Feeding. ASPEN Clinical Nutrition Week 2017
Tools! Largeboregravitybags! EnteraLite®Infinity®pump
! Mayneedtoincreasepumpratetocompensate! Viscositymayresultsininconsistentfeedingtimes
! Bolee™bags
https://www.nutritioncare.org/uploadedFiles/Documents/ASPEN_2018/ASPEN18_Abstracts/WEDNESDAY%20POSTERS%202018.pdf
ItsJustFoodandWater
Recipedevelopment
! Exchanges! Standardrecipe! Platemethod
Recipeidea500kcal(exchanges)INGREDIENT AMOUNT
Starch–well-cookedoatmeal,rice,pastaorpotato ½cup
Yogurt,reducedfat(2%) ¼cup
Milk,1% ¾cup(6oz)
Oil,canola 2teaspoons
Fruit–canned,freshorfrozenapple,banana,peaches,mandarinoranges
½cup
Vegetable–canned,freshorfrozenwellcookedbroccoli,carrots,greenbeansorcauliflower
½cup
Meat–cookedtenderchicken,turkey,beef,fishorsmooth,softtofu ½cup
PROCEDURE:Putallitemsinablenderandmixwell.ThisfitsintoaMagicBullet.Refrigerateifnotusedimmediately.
StandardRecipe1000kcal
FamilyMeals
https://www.choosemyplate.gov/MyPlate-Daily-Checklistaccessed4/25/17
ConsumerRecipeshortcomings! Toomanyfruits/vegetables! Toomuchprotein! Lowinsaltandpotassium! Forgetthecarbohydrate! Toomuchwater! Notenoughwater
Thefollowinginformationisbeingprovidedforalearningexperienceandnottopromoteanyoneproductoveranother.
Commercialproducts1. Compleat®,Compleat®Pediatric,Compleat®
PediatricReducedCalorie,Compleat®OrganicBlends
2. KateFarms®Komplete,CoreEssentials,PeptidePlus1.5,KateFarmsPediatricPeptide1.5,KateFarmsPediatricStandard1.2
3. LiquidHope®andNourish®4. PediasureHarvest™5. RealFoodBlends™6. Ultrient™(comingsoon)
Conclusion! BlendedformulaappearstobeusedinthemajorityofMayo/OleyHENpatients
! Canmeetnutritionneedswiththehelpofaregistereddietitian.
! TherearemanyoptionsavailableforpatientswhowishtouseBTF.
References! HurtR,EdakkanambethVarayilJ,EppL,etal.BlenderizedTubeFeedingUseinAdultHomeEnteral
NutritionPatients:ACross-SectionalStudy.NutrClinPract2015Dec;30(6):824-9.doi:10.1177/0884533615591602
! MundiMS,EppL,HurtRT.IncreasedForceRequiredWithProposedStandardizedEnteralFeedConnectorinBlenderizedTubeFeeding.NutrClinPract,2016Apr18.pii:0884533616639126
! WailaC,VanHoornM,EdlbeckA,etal.TheRegisteredDietitianNutritionist’sGuidetoHomemadeTubeFeeding.JAcadNutrDiet.2016Mar16.pii:S2212-2672(16)00117-9.doi:10.1016/j.jand.2016.02.007.
! Epp,L.,Lammert,L.,Vallumsetla,N.,Hurt,R.T.,Mundi,M.S.UseofBlenderizedTubeFeedinginAdultandPediatricHomeEnteralNutritionPatients.NutrClinPractApril2017
! SullivanMM,Sorreda-EsguerraP,SantosEE,etal.BacterialcontaminationofblenderizedwholefoodandcommercialenteraltubefeedingsinthePhilippines.JHospInfect.Dec2001;49(4):268-273
! UnitedStatesDepartmentofAgricultureFoodSafetyandInspectionService,http://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/safe-food-handling,accessedMay1,2017.! A.S.P.E.N.EnteralNutritionPracticeRecommendations.NormaA.Metheny,CharlesMueller,
SandraRobbins,JacquelineWesselandtheA.S.P.E.N.BoardofDirectors.JPENJParenterEnteralNutr2009;33;122originallypublishedonlineJan26,2009;DOI:10.1177/0148607108330314