Johnson, Teresa W.

AbstractBackgroundPatients with headand neck cancer (HNC) are at high risk for malnutrition before and during chemoradiation treatment. Many will also require tube feeding to address declines in energy intake, weight, and quality of life (QOL) caused by the impact of treatment on gastrointestinal (GI) symptoms. Blenderized tube feeding (BTF) may ameliorate these adverse conditions.MethodsIn this open‐label, prospective pilot study, 30 patients with HNC who required feeding tube placement were recruited to switch from standard commercial formula after 2 weeks to a commercially prepared BTF formula. Weight, body mass index (BMI), GI symptoms, and QOL scores were tracked for 6 weeks from the first week of feeding tube placement.ResultsOf the 16 patients who completed the 6‐week assessment period, weights and BMI scores for 15 patients trended upward. For most patients, QOL and oral intake increased and GI symptoms decreased over the 6‐week period, particularly during weeks 3 and 4, when the impact of treatment is particularly exacting on patients with HNC.ConclusionBTF effectively mitigated weight loss, GI symptoms, QOL scores, and total energy intake in this group of patients with HNC who received tube feeding for 6 weeks.

Abstract Background The number of patients requiring home enteral nutrition (HEN) continues to increase. Many of these patients are interested in using blended food instead of, or in addition to, commercial enteral formula (CEF). Increased risk of food‐borne illness is a concern of blenderized tube‐feeding (BTF). This project assessed a standard procedure for minimizing bacterial growth of BTF prepared in the home setting. Methods Fifty participants prepared BTF in their kitchens using a standard preparation procedure to minimize bacterial contamination. BTF was assessed for growth of aerobic microorganisms, Escherichia coli, Staphylococcus aureus , and coliforms at baseline, 24‐hour, and 48‐hour intervals after preparation for a total of 150 colony forming units (CFU) counts performed. Results No sample had zero aerobic microbial counts; yet no substantial increase in microbial counts was observed during the 48 hours. At baseline and 24 hours, 5/50 (10%) had a CFU count of >10 4 , and at 48 hours, 6/50 (12%) exceeded 10 4 CFUs. Out of 150 CFU counts, 2 (1.3%) were just over 10 5 CFU/mL. Samples exceeding 10 4 CFU/mL were likely contaminated by common endospore‐forming bacteria found in soil or by bacteria in milk that was close to its expiration date. Conclusion In this study, 88% of the samples met the US Food Code criteria for safe food consumption; 10.7% met guidelines for marginal safety by other standards; and 1.3% slightly exceeded 10 5 CFUs. Established safe food‐handling procedures can minimize bacterial contamination of BTF and consequently reduce risk of food‐borne infection in HEN patients.

AbstractThe home enteral nutrition (HEN) population is a medically diverse group whose number has increased substantially in recent decades. Although medically stable compared with acute care patients requiring nutrition support, HEN population needs are unique and require a team approach to manage nutrition. Frequently encountered issues by the HEN team include mechanical issues of the tube site, gastrointestinal and metabolic problems, and patient preferences regarding tube weaning, formula selection, and compliance. A thorough search of the published literature on how to manage these issues was conducted using scientific healthcare databases with the following inclusion criteria: English only, last 10 years, and reviews and clinical trials. Where appropriate, references from the retrieved articles were hand‐searched for relevant articles older than 10 years and cited in this review. The purpose of this review is to provide the HEN team with strategies to address the top issues of home enteral feeding.

AbstractBackgroundMany healthcare facilities and providers prohibit blenderized tube feeding (BTF) for patients who request it due to concerns of high microbial load. The current project compared microbial loads of a standard ready‐to‐feed polymeric commercial formula (CF), a BTF made using baby food (BTF‐BF), and a BTF prepared from blending whole food (BTF‐WF), following food safety standards expected of U.S. hospitals.MethodsThree tube‐feeding formulas (CF, BTF‐BF, BTF‐WF) were prepared in a U.S. hospital and delivered in vitro to an unoccupied patient room. Samples were collected at zero hour, 2 hours, and 4 hours and compared for growth of aerobic microorganisms, Staphylococus aureus, coliforms, and Escherichia coli. The experiment was conducted in triplicate, 1 week apart.ResultsNo S. aureus or coliform/E. coli were detected at any time point following preparation, and total bacterial count was well below acceptable limits. All 3 feeding formulas at zero hour, 2 hours, and 4 hours for each of the 3 sampling dates were acceptable for human consumption.ConclusionJudicious BTF recipe selection and adherence to safe food handling provide a safe feeding substrate equivalent to CF in the hospital setting. Due to increased use and interest in BTF by patients and their caregivers, healthcare facilities may need to reexamine their policies prohibiting BTF use.