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Brown T, Johnson T, Gomes A, Samavat H, Byham-Gray L. Knowledge and clinical practice of ASPEN registered dietitian nutritionist members regarding blenderized tube feedings. Nutr Clin Pract 2024; 39:651-664. [PMID: 38506319 DOI: 10.1002/ncp.11145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/17/2024] [Accepted: 02/25/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Blenderized tube feedings (BTFs) are used by patients/caregivers who report improvements in gastrointestinal tolerance compared with standard commercial feedings. Despite positive outcomes, registered dietitian nutritionists or international equivalents (RDN/Is) hesitate to recommend BTFs. We aimed to determine if an association exists between dietitian characteristics and willingness to recommend BTFs. METHODS A BTF-specific survey (N = 157) assessed for validity and reliability was administered to the American Society for Parenteral and Enteral Nutrition (ASPEN) RDN/I members. Binary logistic regression analyses examined the association between age, years of clinical practice, BTF training/education, patient population served, and willingness to recommend BTFs. RESULTS The response rate was 4.3% of ASPEN RDN/I members. Most respondents were White females with a median age of 39.0 years and 12 years of clinical experience. Although 98.7% of respondents expressed a willingness to support and 73% to recommend BTFs, 60% were not using BTFs in clinical practice. For 94.8% of RDN/Is, the primary reason for BTF use was patient/caregiver requests. After adjustment for age and years of clinical practice, RDN/Is who served pediatric populations (odds ratio [OR] = 4.28; 95% CI, 1.52-12.09) or used three or more professional resources (OR = 2.49; 95% CI, 1.12-5.57), industry-sponsored resources (OR = 3.15; 95% CI, 1.39-7.15), or one or more experiential learning resources (OR = 3.14; 95% CI, 1.38-7.17) were more likely to recommend BTFs whereas those serving adults were less likely to recommend BTFs (OR = 0.33; 95% CI, 0.12-0.95). CONCLUSION Pediatric RDN/Is and individuals with BTF-specific education/training were more inclined to recommend BTFs.
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Affiliation(s)
- Terry Brown
- Food and Nutrition Services, HealthTrust Supply Chain, Coppell, Texas, USA
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, New Jersey, USA
| | | | - Allison Gomes
- Department of Nutrition, Cedar Crest College, Allentown, Pennsylvania, USA
| | - Hamed Samavat
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, New Jersey, USA
| | - Laura Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, New Jersey, USA
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2
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Steel C, Wile H. Dietitian's approach to managing enteral nutrition intolerance when a formula change is indicated: A clinical practice survey. Nutr Clin Pract 2024; 39:641-650. [PMID: 37589316 DOI: 10.1002/ncp.11069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/20/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Enteral nutrition intolerance (ENI) is often defined as one or more gastrointestinal (GI) symptoms related to enteral nutrition (EN) and may have significant impact on patient outcomes. There are multiple strategies to help manage ENI, such as changing the EN formula. The objective of this practice survey was to understand prevalence of ENI, management of ENI symptoms, and EN formula features considered when changing formulas to manage ENI. METHODS Canadian clinical dietitians working across care settings (n = 4827) were invited to complete a 28-question online survey if involved in the management of adult and/or pediatric patients receiving EN. RESULTS Five hundred seventeen surveys were analyzed. Significantly more dietitians in adult vs pediatric settings (83.4% and 59.1%, respectively; P = 0.0012), reported ENI in <40% of patients. Assessing medications, elevating the head of the bed, and changing EN infusion rate, volume, or feeding regimen were the highest-ranked strategies to manage ENI symptoms. Most (>90%) respondents change the EN formula <50% of the time to manage ENI. Dietitians consider caloric density and protein form as the most important EN features to manage upper-GI symptoms vs fiber source, osmolality, and form of protein to manage lower-GI symptoms. EN with real-food ingredients was ranked higher in importance for managing upper- and lower-GI symptoms by dietitians in pediatric vs adult settings. CONCLUSION To manage ENI symptoms, dietitians consider multiple strategies before deciding to change the EN formula. When a formula change is indicated, dietitians consider different EN features for the management of upper- and lower-GI symptoms.
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Affiliation(s)
- Cindy Steel
- Nestlé Health Science Canada, North York, Ontario, Canada
| | - Heather Wile
- Nestlé Health Science Canada, North York, Ontario, Canada
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3
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Doyle C, Louw J, Shovlin A, Dowd L, Kavanagh M. Blended feeding in gastrostomy-fed children-A scoping review. Child Care Health Dev 2024; 50:e13222. [PMID: 38265135 DOI: 10.1111/cch.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/08/2023] [Accepted: 12/03/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Blended feeding has become increasingly prevalent in recent years with its practice gaining some momentum. With anecdotal reports of benefits and little evidence of harm in the literature regarding blended feeding, this scoping review was deemed important. The aim of this scoping review was to summarise the published evidence about blended feeding in gastrostomy-fed children. METHOD The scoping review methodology used included searches in specific online databases: PUBMED, PsychINFO, CINAHL, SCOPUS, AMED and EMBASE for articles that addressed issues pertaining to blended feeds in gastrostomy-fed children. Grey literature was also considered. Inclusion criteria included papers that pertained to information and research on blended feeding in gastrostomy-fed children. Studies published in English over the past 11 years (2011-2022) were included. This resulted in 59 papers being included in this scoping review. RESULTS Thematic analysis of the literature identified eight overall themes. It was clear that parents found blended feeding promoted the normalising of feeding, their own involvement in decision-making around foods and promotion of a socially inclusive mealtime. The need for dietician and health professional input and support is key, whereas a lack of guidelines acts as a barrier to blended feeding. Furthermore, risks associated with blended feeding are identified but also the benefits to the physical well-being of the child are considered. CONCLUSION The review was comprehensive in that it identified a broad range of literature, exploring the extent, range and nature of research activity related to the use of blended feeds. The lack of original research is a concern. However, it is expected this review will provide direction for researchers, and in particular inform policy and practitioners working in the field where blended feeds may be an option for gastrostomy-fed children.
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Affiliation(s)
- Carmel Doyle
- School of Nursing & Midwifery, Trinity College, Dublin, Ireland
| | - Julia Louw
- Trinity Centre for Practice and Healthcare Innovation, Trinity College, Dublin, Ireland
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Phillips G, Coad J. Blended diets for tube-fed children and young people: a rapid review update. Arch Dis Child 2023; 108:1014-1018. [PMID: 37595987 DOI: 10.1136/archdischild-2023-325929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Many children and young people with complex health and care needs use enteral feeding tubes to optimise their nutritional intake in the UK and other countries. Blended diets as an alternative to the exclusive use of commercial formula are becoming more commonly used, and there is evidence to support the benefits of using a blended diet on the child or young person and their wider family.A rapid review was published in 2017 exploring blended diets as a valid alternative to commercial formula for enteral feeding for children and young people. An update was necessary to ensure that professional practice is informed by the latest evidence, which has expanded significantly since the publication of the original article. METHODS A rapid review method was used and the PRISMA checklist formed the basis of the protocol devised ahead of data collection. Key databases included: PubMed, MEDLINE, CINAHL, PsychINFO, Google Scholar. RESULTS 29 articles were included and four themes were identified from the collated data. (1) Symptom improvement and clinical outcomes, (2) nutritional content, (3) caregiver experiences and (4) blended diet practices. Findings showed that blended diets can have a positive impact on physical symptoms as well as social influences extending to families and carers. CONCLUSION Nutritional content, food hygiene and viscosity of food blends are important considerations for professionals and families to ensure safe practice when using blended diets for enteral feeding.
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Affiliation(s)
| | - Jane Coad
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Steel C, Wile H, Li O, Yedulla S, Hare I, Hopkins B. Understanding the use and tolerance of a pediatric and an adult commercial blenderized enteral formula through real-world data. Nutr Clin Pract 2023; 38:449-457. [PMID: 36036217 DOI: 10.1002/ncp.10905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/13/2022] [Accepted: 07/30/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Home enteral nutrition (HEN) is frequently prescribed to individuals who cannot consume adequate food orally. Commercial blenderized enteral formulas (CBEF) containing real-food ingredients are becoming more popular and more widely available; however, the demographics of patients receiving these formulas have rarely been evaluated, and little data are available on patient tolerance in the community. METHODS US claims data were obtained for children and adolescents/adults who used the CBEF of interest as the sole source of nutrition via enteral feeding tube in the community setting following discharge from acute care. Demographics, concomitant medications, clinical diagnoses, and Charlson Comorbidity Index scores were tabulated using descriptive statistics. Gastrointestinal (GI) symptoms before and after hospital discharge were compared using significance tests. RESULTS The study included 231 participants (180 children, 51 adolescents/adults). CBEFs were prescribed to patients with a variety of diagnoses, of which the most common were digestive and respiratory disorders. Children experienced significantly lower rates of diarrhea, nausea, vomiting, constipation, and abdominal distension in the weeks following hospital discharge compared with the baseline (all P < 0.001). Adolescents/adults experienced significantly lower rates of constipation, nausea, and vomiting (all P < 0.05). Neither group increased their usage of GI medications following hospital discharge. CONCLUSION These CBEFs, based on real-food ingredients, were prescribed to diverse patients in the community and were well tolerated. These formulas offer an alternative to standard polymeric formulas and an alternative or adjunct to homemade blenderized formulas.
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Affiliation(s)
- Cindy Steel
- Nestlé Health Science Canada, North York, Ontario, Canada
| | - Heather Wile
- Nestlé Health Science Canada, North York, Ontario, Canada
| | - Olivia Li
- Clarivate Data Analytics & Insights, Toronto, Ontario, Canada
| | | | - Ian Hare
- Clarivate Data Analytics & Insights, Bicester, UK
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Dipasquale V, Aumar M, Ley D, Antoine M, Romano C, Gottrand F. Tube Feeding in Neurologically Disabled Children: Hot Topics and New Directions. Nutrients 2022; 14:nu14183831. [PMID: 36145204 PMCID: PMC9506511 DOI: 10.3390/nu14183831] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022] Open
Abstract
Tube feeding is a therapeutic intervention that is aimed at providing nutritional support and is important in the nutritional and gastrointestinal management of children with neurological disability (ND) worldwide. Since the publication of the first European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) consensus paper in 2017, some aspects of tube-feeding modalities have attracted the interest of the scientific community more than others, including the type of enteral formulas, enteral access, and the challenging practice of tube weaning. The purpose of this review was to report on the most recent hot topics and new directions in tube-feeding strategies for children with ND.
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Affiliation(s)
- Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, 98124 Messina, Italy
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
- Correspondence:
| | - Madeleine Aumar
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
- University Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, F59000 Lille, France
| | - Delphine Ley
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
- University Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, F59000 Lille, France
| | - Matthieu Antoine
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, 98124 Messina, Italy
| | - Frédéric Gottrand
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
- University Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, F59000 Lille, France
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Dipasquale V, Diamanti A, Trovato CM, Elia D, Romano C. Real food in enteral nutrition for chronically ill children: overview and practical clinical cases. Curr Med Res Opin 2022; 38:831-835. [PMID: 35274578 DOI: 10.1080/03007995.2022.2052514] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Many feeding strategies may be used in chronically ill children on enteral nutrition. Interest is currently growing in real food-based enteral nutrition. A new tube feeding formula with real food ingredients is currently commercially available in Europe. CASE REPORTS By focusing on four clinical cases, this article illustrates the use of a tube feeding formula with real food ingredients in pediatric patients with various complex conditions. The formula contains a milk-based mixture of peas, green beans, peaches, carrots, and chicken, and provides 1.2 kcal/ml. It was offered under medical supervision and after full consideration of all feeding options. CONCLUSIONS Formula choice appears to be based on clinical experience and must be individualized to patients' characteristics and needs. Real food-containing formulas seem to improve tolerance and feeding outcomes as well as promote family inclusion and mealtime engagement, but further studies are warranted.
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Affiliation(s)
- Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Antonella Diamanti
- Hepatology Gastroenterology and Nutrition Unit, "Bambino Gesù" Children Hospital, Rome, Italy
| | - Chiara Maria Trovato
- Hepatology Gastroenterology and Nutrition Unit, "Bambino Gesù" Children Hospital, Rome, Italy
| | - Domenica Elia
- Hepatology Gastroenterology and Nutrition Unit, "Bambino Gesù" Children Hospital, Rome, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
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8
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Soscia J, Adams S, Cohen E, Moore C, Friedman JN, Gallagher K, Marcon M, Nicholas D, Weiser N, Orkin J. The parental experience and perceptions of blenderized tube feeding for children with medical complexity. Paediatr Child Health 2021; 26:462-469. [PMID: 34987677 PMCID: PMC8711682 DOI: 10.1093/pch/pxab034] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/03/2021] [Indexed: 01/11/2023] Open
Abstract
Objectives Parents of children with medical complexity are often expected to implement complicated plans of care, such as enteral tube feeding, to support the health of their child. Enteral feeding can have psychosocial implications for the parent, child, and family. Blenderized tube feeding (BTF) refers to the administration of pureed food and drinks through a feeding tube. Little is known regarding parents’ experiences with BTF. Therefore, the purpose of this qualitative study was to understand the lived experience of BTF from the parent’s perspective. Methods This qualitative study was a grounded theory analysis utilizing semi-structured interviews of parents who provided at least 50% of their child’s diet through BTF. Participants were recruited using purposive sampling from the Complex Care Program at a tertiary care paediatric centre. Interviews were conducted until thematic saturation was achieved. Themes were identified using constant comparative analysis of transcribed interviews. Results Parents (n=10) felt that BTF positively affected the experience of tube feeding and enhanced their child’s health and wellbeing. Parents described BTF as a means of self-empowerment and a mechanism to normalize feeding and care for the entire family. Despite reporting BTF as more time consuming than formula feeding, all parents were satisfied with having made the change, and planned on continuing the diet. Conclusion BTFs can improve the experience of tube feeding and positively address some of the negative psychosocial implications of enteral tube feeding, providing a sense of normalcy and control for parents caring for a child with medical complexity.
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Affiliation(s)
- Joanna Soscia
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sherri Adams
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eyal Cohen
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clara Moore
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeremy N Friedman
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Gallagher
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margaret Marcon
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary (Edmonton Division), Edmonton, Alberta, Canada
| | - Natalie Weiser
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julia Orkin
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Kariya C, Vardi L. Blenderized Tube Feeding and Enterostomy Tube Occlusions Among Adults with Amyotrophic Lateral Sclerosis and Primary Lateral Sclerosis. CAN J DIET PRACT RES 2021; 82:196-199. [PMID: 34582277 DOI: 10.3148/cjdpr-2021-019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Adults with amyotrophic lateral sclerosis (ALS) and primary lateral sclerosis (PLS) may develop swallowing difficulties and elect to receive an enterostomy feeding tube for nutrition support. Blenderized tube feeding (BTF) appeals to those interested in a homemade enteral nutrition option, but there are concerns of feeding tube occlusion and limited research on this potential risk. Therefore, our purpose was to determine the frequency of, and risk factors for, feeding tube occlusions among adults with ALS or PLS who use BTF. For this retrospective study, the electronic medical records of tube-fed adults with ALS or PLS who received outpatient care at a provincial ALS clinic during a two-year period were reviewed (n = 651). There were 97 tube-fed patients identified, of which 20 (21%) used BTF. Average duration of BTF use was 11.25 ± 7.5 months. Seven subjects (35%) used BTF exclusively, while 13 (65%) used a combination of BTF and commercial enteral formula. All received BTF by gastrostomy tube, sized 14 to 24 French. BTF administration methods and compliance with water flush recommendations varied. Despite the perceived risk of feeding tube occlusions with blenderized tube feeding, no occlusions were found to have occurred in this study.
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Affiliation(s)
- Claire Kariya
- Vancouver Coastal Health Authority, Vancouver General Hospital, Department of Clinical Nutrition, Vancouver BC.,University of British Columbia, Faculty of Land and Food Systems, Dietetics, Vancouver BC
| | - Lisa Vardi
- Vancouver Coastal Health Authority, GF Strong Rehabilitation Centre, ALS Centre, Vancouver BC
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