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|Tube Talk: Further Updates on Blenderized Diet Use with New Enteral Connectors|
Further Updates on Blenderized Diet Use with the New Enteral Connectors
Peggi Guenter, PhD, RN, and Don McMichael
In the May/June issue of the LifelineLetter, Tom Hancock from GEDSA wrote "Enteral Connector Changes: FAQs for Blenderized Diet and Other Patient/Caregiver Concerns.” One of the questions posed was, "Will thicker formulas and blenderized foods pass through the new ENFit connector?” As a follow-up to this question, GEDSA, Kimberly-Clark engineering staff, and A.S.P.E.N. staff developed a protocol and conducted experiments, which were carried out after the May/June issue was published. We’d like to share the results here.
The testing purpose was to determine the flow rate of blenderized diet formulas through various available feeding tube components and systems, comparing current feeding tube systems with those with a proposed ENFit connector system. Testing was performed with commercially available viscous formulas, water, applesauce, and a commercially prepared blenderized diet. All fluids were meant to replicate what is used in practice. Each test was done ten times with each tube and results were averaged.
Kimberly-Clark 18fr/20fr feeding tube systems were used for this testing, including:
Three types of testing were conducted. First, the viscosity of each fluid or formula was measured to determine the thickness of each; the higher the number, the thicker (more viscous) the formula. The blenderized formula was thick, but not as thick as the Japanese formula or the applesauce (see Figure 1).
The second type of testing was designed to determine how much pressure was required to dispense or push the formulas through a 60mL syringe (catheter tip and ENFit). Figure 2 demonstrates the pressure (or pounds of force) it took to push the formulas through the two syringes and tube delivery system at room temperature. The blenderized diet was tested just coming out of the refrigerator to simulate clinical conditions. It took about 8 to 10 pounds of force to push the blenderized formula through the system, but was actually easier with the ENFit connector. The results for all of the tubes were similar in that there was no significant difference in the amount of pressure needed to push through the new ENFit connector.
The third type of testing was designed to check gravity flow through the connectors. Formulas were allowed to flow through a feeding tube system with a minimal (18”) pressure head. Figure 3 demonstrates how much formula or fluid would flow through each of the systems in mL/ minute. Comparing the standard catheter tip syringe and the new ENFit connector, there was little difference in the gravity flow of the blenderized diet through two types of gastrostomy tubes when using formula right from the refrigerator.
The new ENFit feeding design standards were developed with current practice in mind and specific requirements to avoid any disruption of therapy. Blenderized formulas are not all the same and tubes vary as well. In this study, with these tubes and formulas, the flow and pressure requirements for ENFit and cath-tip syringes were essentially equivalent. If your formula goes through the cath-tip syringe, it should go through the ENFit connector.
It is recommended that each company perform testing on its tubes with a variety of formulas. For more information or if you have questions about your EN device or delivery system, contact the manufacturer directly and check the GEDSA Web site, www.StayConnected2014.org.
Peggi Guenter, PhD, RN, is the Senior Director for Clinical Practice, Quality, and Advocacy for the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Don McMichael is Product Development Engineer with Kimberly-Clark Health Care.
LifelineLetter, July/August 2014