Determinant Factors of the Viscosity of Enteral Formulas

Semisolid vs Liquid Nutrients and 30-Day Readmission in Gastrostomy Tube-Fed Patients: A Propensity-Matched Analysis

BACKGROUND

Semisolid nutrients have been widely used to prevent complications related to enteral nutrition (EN) in Japan. However, there are few data on the effect of feeding semisolid nutrient preparations. We compared 30-day readmission rates of gastrostomy tube-fed patients who had been prescribed semisolid vs liquid nutrients on discharge.

METHODS

This is a retrospective observational study using a Japanese nationwide inpatient database of data entered between June 2014 and March 2018. We identified patients aged ≥18 years who had received EN through gastrostomy during hospitalization. Patients were classified as having been prescribed semisolid vs liquid EN on discharge. After one-to-one propensity score matching, all-cause 30-day readmission rates were compared between the 2 groups.

RESULTS

In total, 5331 patients were identified, including a semisolid-nutrients group (n = 2089) and a liquid-nutrients group (n = 3242). Propensity score matching created 1912 pairs. The 30-day readmission rates were 15.6% and 13.9% in the semisolid-nutrients and liquid-nutrients groups, respectively. No significant difference was observed between the groups (risk difference, 1.7%; 95% CI, -0.6 to 4.0%; P = .14).

CONCLUSION

All-cause 30-day readmission of patients receiving gastrostomy tube feeding did not differ between those prescribed semisolid vs liquid nutrients on discharge. Randomized controlled trials are needed to accurately determine the effect of semisolid nutrients on clinical outcomes.

Causes of nasoenteral tube obstruction in tertiary hospital patients

BACKGROUND/OBJECTIVES

Obstruction of the nasoenteral tube is one of the complications of enteral nutrition therapy, and its causes and frequency of occurrence are not well understood. To evaluate the causes of enteral nutrition feeding tube obstruction. To study the time elapsed between the beginning of the nutrition therapy and the obstruction of the tube.

SUBJECTS/METHODS

This was a retrospective cohort study of 1170 patients aged 18 years or older who were hospitalized at Sírio-Libanês Hospital between January 2015 and October 2017, and who were undergoing enteral nutrition therapy delivered using an infusion pump through a nasogastric or nasoenteral tube. The study population included 683 (58%) men and 487 (42%) women. The median age was 79 years. Of these, 1084 patients received enteral nutrition and medication through the feeding tube, and 86 received medication alone. Variables investigated as causes of feeding tube obstruction were the administration of medication through the tube, type of diet, and use of symbiotics.

RESULTS

Obstruction rates were 4% for up to 40 days of observation and 8% for the total observation time. The time for obstruction of 10% of the tubes in patients receiving rivaroxaban, linagliptin, metformin, and nystatin was 16, 19, 20, and 28 days, respectively.

CONCLUSIONS

The main cause of nasoenteral tube obstruction (odds ratio) was the combination of metformin (2.0), nystatin (3.1), linagliptin (4.3), rivaroxaban (2.4), and a high-protein diet (1.9). Overall, proper tube care and strict compliance with tubal drug delivery guidelines can result in low tube obstruction rates.

Detecting Enteral Nutrition Residues and Microorganism Proliferation in Feeding Tubes via Real-Time Imaging

BACKGROUND

Enteral nutrition (EN) residues that persist in feeding tubes provide substrates for microorganisms to proliferate and occlude the tubes. Visible EN residues in tubes are easily identified, but smaller residues can persist. We developed a new imaging technique to visualize EN residues and proliferation of microorganisms in feeding tubes.

MATERIALS AND METHODS

(1) Feeding tubes containing EN labeled with fluorescent dye and either with or without various types or amounts of thickeners were flushed once with water and then seeded with Pseudomonas aeruginosa Xen05 with recombinant luciferase DNA. (2) Because EN fluoresces intrinsically, EN in the feeding tubes without fluorescent dye was repeatedly flushed until the intrinsic fluorescence levels reached background levels. Fluorescent images of EN residues and bioluminescent images of microorganisms were acquired via an optical imaging system.

RESULTS

(1) Fluorescence images showed that the amount of EN residues increased at various sites in tubes depending on EN viscosity and the thickening agent, and bioluminescence images showed that microorganism proliferation was associated with a commensurate increase in EN residues. (2) The intrinsic fluorescence of EN also enabled the detection of EN residues in tubes even in the absence of fluorescence dye. Higher EN viscosity required more flushes to reach undetectable levels.

CONCLUSION

EN residues and microorganism proliferation in enteral feeding tubes were detected on fluorescence and bioluminescence images, respectively. This simplified approach allowed the real-time visualization of EN residues and microorganisms in feeding tubes.