Blended diet in enteral feeding: current guidance.

The practice of administering blended food via enteral feeding tubes has been growing in popularity in recent years. Concerns have been raised as this practice was perceived to increase risk of gastrointestinal intolerance, allergic reactions, nutritional insufficiency, tube blockages, and infection compared with using commercial enteral feed (CEF), the gold standard, as well as risk of litigation against the professional due to their support of practice that is not evidence-based. However, research has shown that the physical, social and emotional benefits from receiving blended diet may outweigh the previously suggested risks. Guidance has been updated to encourage discussions around blended diet while informing the tube-fed individuals, families and carers of potential risks, potential benefits, barriers, considerations for training, safety and contraindications.

Evaluation of community nurse-led traumatic tube displacements.

Home enteral tube feeding (HEF) has many benefits and is largely safe practice. Some complications have historically required intervention in the acute setting, including traumatic displacement of feeding tubes (i.e. internal bumper/balloon removed intact), and evidence to support the safe replacement of these tubes in the community is lacking. To address this, a service enabling community homecare nurses (CHN) to replace traumatically displaced feeding tubes was designed and evaluated. Adult patients presenting with a traumatically displaced feeding tube over 29 months were included in the service evaluation. Baseline characteristics and outcomes at day 1, 7 and 6 months post-replacement were recorded. A total of 71 tube replacements were performed by CHNs in 60 patients. No clinical complications were recorded at any follow-up points. A simple cost analysis estimated savings of £235 754.40. These results suggest that nurse-led replacement of traumatically displaced feeding tubes in adults in the community is low-risk and offers potential cost savings.

Comparison of anxiety and depression levels in caregivers of patients with percutaneous endoscopic gastrostomy for home enteral tube feeding against other enteral nutrition methods.

BACKGROUND: The aim of the study was to demonstrate whether the care burden of caregivers of bedridden patients, who experience feeding difficulties, decreases according to the Hospital Anxiety and Depression Scale (HADS) (1) after the patient has undergone PEG (Percutaneous Endoscopic Gastrostomy). The hypothesis of the study was that the levels of anxiety and depression of caregivers for patients fed via PEG decrease more than those for caregivers of patients fed through other enteral methods. Based on this, the goal is to recommend to palliative care and home care professionals the type of feeding method for bedridden patients that will create less burden on their relatives. METHODS: A comparison was made of the Hospital Anxiety and Depression Scale (HADS) scores among caregivers of patients receiving PEG and other enteral nutrition, focusing on changes between hospital admission and discharge. These changes were analyzed based on the caregiver's age, gender, and the duration of the patient's hospital stay. METHODS: This study conducted a comparative analysis of the Hospital Anxiety and Depression Scale (HADS) scores among caregivers of patients receiving Percutaneous Endoscopic Gastrostomy (PEG) versus other forms of enteral nutrition. The focus was on the variation in these scores from the time of the patients' hospital admission to their discharge. This analysis incorporated an examination of how these changes correlated with the caregiver's age and gender, as well as the duration of the patient's hospitalization. RESULTS: Despite longer hospital stays, a decrease in anxiety and depression was observed in caregivers of patients receiving PEG compared to the other group (p = 0.078). It was found that the decrease in anxiety and depression levels was less pronounced with increasing age of the caregiver (r=-0.202, p = 0.038). Hospital stay duration for patients receiving PEG was significantly longer than for those receiving other enteral nutrition methods (p = 0.017). CONCLUSIONS: We believe that Percutaneous Endoscopic Gastrostomy (PEG) should be the preferred method for long-term enteral nutrition due to its facilitation of effective and comfortable feeding and medication administration by caregivers. In palliative care services, for patients requiring long-term nutrition, PEG should be considered more prominently than other enteral feeding methods to reduce the anxiety of caregivers.

Factors Associated with Growth in a Cohort of Children with Complex Biventricular Congenital Heart Disease.

OBJECTIVES: To evaluate patterns and determinants of longitudinal growth among children requiring complex biventricular repair for congenital heart disease, as well as to assess for associations of growth with early feeding modality, comorbidities, postoperative complications, and socioeconomic characteristics. STUDY DESIGN: A single-institution retrospective cohort study was performed in children born February 1999 to March 2009 with complex congenital heart disease who underwent biventricular repair before age 4 years, defined by Risk Adjustment in Congenital Heart Surgery-1 category 3-5. Clinical characteristics, height, weight, and body mass index (BMI) from ages 2-12 years were collected by chart review. Neighborhood-level socioeconomic data were identified using a geographic information system approach. The adjusted association of covariates with growth outcomes was estimated using multivariable linear regression models using generalized estimating equations. RESULTS: Compared with population growth curves, the cohort (n = 150) trended toward early decrease in age-adjusted weight and height. Early tube feeding was significantly associated with decreased BMI before adolescence (-0.539; 95% CI -1.02, -0.054; P = .029). In addition, other clinical and perioperative characteristics had significant associations with growth, including low birth weight, preoperative tube feeds, need for multiple bypass runs, and diagnosis of feeding disorder. CONCLUSIONS: Early childhood growth in children with complex biventricular repair may be impaired. Early tube feeding was associated with decreased BMI over the course of early childhood, which may indicate a need for continued close nutrition follow-up and support even beyond the duration of tube feeds.

Preparing Enteral Formulas for Adult Patients with Phenylketonuria: A Minor Necessity but Major Challenge-A Case Report.

Phenylketonuria (PKU) is the most frequent of the congenital errors of amino acid (AA) metabolism worldwide. It leads to the accumulation of the essential AA phenylalanine (Phe) and it is associated with severe neurological defects. The early diagnosis and treatment of this rare disease, achieved through newborn screening and low-Phe diet, has profoundly changed its clinical spectrum, resulting in normal cognitive development. We face the first generation of PKU patients perinatally diagnosed and treated who have reached adulthood, whose special needs must be addressed, including feeding through enteral nutrition (EN). However, recommendations regarding EN in PKU constitute a gap in the literature. Although protein substitutes for patients with PKU are offered in multiple forms (Phe-free L-amino acid or casein glycomacropeptide supplements), none of these commercial formulas ensures the whole provision of daily total energy and protein requirements, including a safe amount of Phe. Consequently, the combination of different products becomes necessary when artificial nutrition via tube feeding is required. Importantly, the composition of these specific formulas may result in physicochemical interactions when they are mixed with standard EN products, leading to enteral feeding tubes clogging, and also gastrointestinal concerns due to hyperosmolality. Herein, we present the first reported case of EN use in an adult patient with PKU, where the separate administration of protein substitutes and the other EN products avoided physicochemical interactions.

A scoping review of best practices in home enteral tube feeding.

AIMS: To review the experiences of healthcare professionals (HCPs) and service users on the provision and receipt of home enteral nutrition (HEN) in primary care settings, respectively. BACKGROUNDS: HEN supports the nutritional needs of service users in primary care settings who are unable to meet their nutritional requirements through oral intake alone. While HEN supports service users to remain in their home, the provision of HEN services can be variable. The prevalence of HEN is increasing as health systems shift delivery of care from acute to primary care settings, and therefore the evolving needs of HCPs and service users in relation to HEN deserve exploration. METHODS: Quantitative and qualitative studies were included if they described (1) practices that support best outcomes in adults on HEN and residing in their own homes and/or (2) service user and HCP experiences of HEN. Studies on the economics of HEN were included. Databases searched included MEDLINE/PubMed, EMBASE, Web of Science, and CINAHL. Publications up to March 2021 were included. A descriptive analytical approach was used to summarise the findings. FINDINGS: Key themes included the importance of initial education to enable service users to adapt to HEN and the need for support from knowledgeable HCPs. Access to support from HCPs in primary care was limited, and some HCPs felt their knowledge of HEN was inadequate. Service users highlighted the significant impact of HEN on daily living and emphasised the need for support from a HEN team. HEN services were also associated with reduced hospital admissions, lengths of stay in hospital, and costs of hospitalisation. CONCLUSIONS: A specialist HEN service can manage enteral nutrition-related complications, reduce unnecessary hospital admissions, and improve quality of care and patient satisfaction. Further education of HCPs is needed on the provision of HEN.

Prevalencia y factores asociados a la hiponatremia en pacientes con nutrición enteral / Hyponatremia among patients with total enteral tube feeding: prevalence and associated clinical factors

Introducción: la hiponatremia es el trastorno electrolítico más frecuente a nivel hospitalario. En pacientes con nutrición enteral (NE) puede influir en el abordaje terapéutico, así como en la selección del preparado nutricional. Objetivos: describir la prevalencia de la hiponatremia en pacientes con NE y factores asociados. Métodos: estudio retrospectivo de 1651 pacientes no críticos con NE, valorados por el Servicio de Endocrinología y Nutrición desde enero de 2014 hasta enero de 2020. Se recogieron la edad, el sexo, el índice de masa corporal (IMC) (kg/m2), el estado nutricional mediante el cuestionario Mini Nutritional Assessment (MNA), el diagnóstico principal y la presencia de hiponatremia al inicio y durante la NE. Resultados: del total, el 53,9 % fueron hombres, con una mediana de edad de 76,8 [65,7-85,3] años. El diagnóstico principal más frecuente fue la patología neurológica (37,3 %). El 26,1 % de los pacientes presentaron hiponatremia: un 11,0 % al inicio de la NE y el 16,7% durante su administración. La hiponatremia fue más frecuente en aquellos con patología digestiva (28,7 %) e infecciosa (27,65 %). Según el MNA, hasta el 41,1 % presentaron desnutrición y la frecuencia de esta fue estadísticamente superior en los pacientes con que en aquellos sin hiponatremia (76,3 % vs. 55,8 %; p < 0,001). En el análisis multivariante, únicamente la desnutrición se asoció de manera significativa con la presencia de hiponatremia, con una OR de 2,86 [IC 95 %: 1,5-4,88]. Conclusiones: la hiponatremia se detectó en un tercio de los pacientes con NE. Su presencia fue hasta 2 veces más frecuente en los pacientes desnutridos, independientemente de la edad, el sexo, el IMC y la patología basal (AU)

Introduction: hyponatremia is the most frequent disturbance in hospitalized patients. This situation may influence the therapeutic approach in patients with total enteral tube feeding (TEN). Objective: to study the prevalence of hyponatremia and the clinical factors that are associated with increased risk in a population with TEN. Methods: a retrospective study from January 2014 to January 2020; 1,651 non-critically ill patients receiving TEN were included who were assessed by the Department of Endocrinology and Nutrition. Data collected included sex, age, body mass index (BMI) (kg/m2), and nutritional status by Mini Nutritional Assessment (MNA); main disease diagnosis and development of hyponatremia at onset or during TEN were also included. Results: in all, 53.9 % of the total sample were males aged 76.8 [65.7-85.3] years. Neurological pathology was the most frequent primary diagnosis on admission (37.3 %). We found hyponatremia in 26.1 % —11.0 % at onset and 16.7 % during TEN—. Hyponatremia was more frequent in patients with digestive disease (28.7 %) and infectious disease (27.65 %). According to the MNA questionnaire 41.1 % were malnourished and nutritional status was worse in patients with hyponatremia (76.3 % vs. 55.8 %; p < 0.001). By multivariate analysis, malnutrition was only associated with hyponatremia status; OR, 2.86 [95 % CI: 1.5-4.88]. Conclusions: in this study, hyponatremia was detected in a third of patients. This was up to two more times as common in malnourished patients; however, age, sex, BMI, and baseline pathology were not related (AU)

Promoting enteral tube feeding safety and performance in preterm infants: A systematic review.

BACKGROUND: Enteral tube feeding is commonly used in preterm infants to provide enteral nutrition. Nurses play a crucial role in promoting feeding safety and performance. OBJECTIVES: The aims of this systematic review were to identify nursing practices regarding feeding safety and performance promotion in preterm infants with enteral tube feeding and summarize evidence on the effectiveness of these practices. METHODS: A comprehensive search was performed in six databases (MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Library, and Scopus). Studies on nursing practices aimed at promoting feeding safety and performance in preterm infants with enteral tube feeding were included. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for randomized controlled studies and the tool of risk-of-bias in non-randomized studies of interventions (ROBINS-I) for non-randomized studies of interventions. A narrative synthesis strategy was employed to gather evidence and analyze data. RESULTS: 61 studies (47 randomized controlled studies and 14 quasi-experimental studies) covering seven categories of practices were included. The identified nursing practices included controlling feeding interval, selecting feeding position, monitoring gastric residual, disposing of gastric residual, managing feeding temperature, feeding promotion stimulation, and supplementary methods during the transition from tube to oral feeding. Evidence supported the effectiveness of oro-motor stimulation and non-nutritive sucking as feeding performance promotion strategies in preterm infants. Other practices were suggested to be used cautiously or recommended to be further studied due to limited evidence. CONCLUSIONS: The review identified seven categories of nursing practices in promoting feeding safety and performance in preterm infants receiving enteral tube feeding. Oro-motor stimulation and non-nutritive sucking can be used in clinical settings to promote feeding performance in preterm infants with enteral tube feeding. Other practices will continue to be dictated by local preferences and cost factors until more robust evidence becomes available. REGISTRATION: PROSPERO database (CRD42020196256).

Introduction of blended diet for enteral tube feeding in paediatrics: A case report.

Background: Advances in medical technology have resulted in changes to enteral tube feeding (ETF). Standard practice in the UK is to use commercial formula for ETF via the stomach or small intestine; however, blended diets are becoming increasingly popular. Emerging evidence shows benefits of a blended diet although evidence informing clinical guidance is sparse. Consequently, there is disparity in practice, and it remains unclear which patient groups may benefit most from a blended diet. Aim: To demonstrate the initiation of a blended diet in clinical practice. Methods: This case report features a 2-year-old child requiring ETF in the context of hypotonia, developmental delay and faltering growth. Results: In this instance, a blended diet resulted in improved gastrointestinal symptoms and adequate growth. Conclusion: This case demonstrates the successful implementation of a blended diet and associated benefits. Blended diets may benefit others requiring ETF and should be considered on an individualised basis.

Medium-Chain Triglyceride (MCT) Content of Adult Enteral Tube Feeding Formulas and Clinical Outcomes. A Systematic Review.

Available data on the effect of lipid composition of enteral formulas on clinical outcomes are controversial. The present systematic review was performed in order to verify whether the presence of specific lipidic substrates, namely medium-chain triglycerides (MCT), in enteral tube feeding formulas is associated to measurable clinical benefits in patients receiving enteral nutrition in different clinical settings, including home enteral nutrition (HEN). The results of this systematic review highlight a lack of robust evidence supporting the use of specific types of lipids in standard or disease-specific formulas. Evidence exists, however, that MCT-containing formulas are safe and well-tolerated. Further, well-designed, adequately powered, randomized controlled trials would be needed in order to assess the superiority of MCT- containing enteral formulas over other standard or disease-specific commercially available enteral products.

Delivery of a nutritional prescription by enteral tube feeding in children with chronic kidney disease stages 2-5 and on dialysis-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce.

The nutritional prescription (whether in the form of food or liquid formulas) may be taken orally when a child has the capacity for spontaneous intake by mouth, but may need to be administered partially or completely by nasogastric tube or gastrostomy device ("enteral tube feeding"). The relative use of each of these methods varies both within and between countries. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPRs) based on evidence where available, or on the expert opinion of the Taskforce members, using a Delphi process to seek consensus from the wider community of experts in the field. We present CPRs for delivery of the nutritional prescription via enteral tube feeding to children with chronic kidney disease stages 2-5 and on dialysis. We address the types of enteral feeding tubes, when they should be used, placement techniques, recommendations and contraindications for their use, and evidence for their effects on growth parameters. Statements with a low grade of evidence, or based on opinion, must be considered and adapted for the individual patient by the treating physician and dietitian according to their clinical judgement. Research recommendations have been suggested. The CPRs will be regularly audited and updated by the PRNT.

Quick and effective improvement of leucine enriched dietary supplement on malnutrition in acute stroke patients receiving enteral tube feeding.

BACKGROUND: Malnutrition often occurs in acute stroke patients receiving enteral tube feeding (ETF). Unless malnutrition is improved, their clinical outcome is poor. However, strategies to improve malnutrition in these patients have not been established. Branched-chain amino acids (BCAA) may enhance protein synthesis and attenuate inflammation. Our study aimed to investigate whether a leucine enriched BCAA dietary supplement (LEBDs) could quickly increase serum levels of albumin (Alb) or transthyretin (TTR) and decrease high-sensitivity C-reactive protein (CRP) in the development of severe malnutrition within a few days after stroke onset compared to standard BCAA dietary supplement (SBDs). METHODS: We retrospectively included acute stroke patients who: 1) were admitted between August 2016 and July 2017; 2) underwent ETF for 7 days or longer after admission, and 3) underwent blood examination of Alb, TTR, and CRP on admission, the fifth day and the seventh day. We defined severe malnutrition as severe hypoproteinemia: decrease of TTR to less than 15 mg/dl on the 5th day. In LEBDs and SBDs groups, patients started to receive a dietary supplement containing leucine of 1.44 and 0. 72 g twice a day on the fifth day, respectively. We evaluated Alb (g/dl), TTR (mg/dl), and CRP (mg/dl) on admission, the fifth day, and the seventh day. RESULTS: Twenty-nine patients met our inclusion criteria:15 in LEBDs and 14 in SBDs. In LEBDs and SBDs groups, the median Alb was 3.5 and 3.3 g/dl, TTR was 12.7 and 10.7 mg/dl, and CRP was 1.02 and 0.673 mg/dl on admission, respectively. In LEBDs, the median Alb and TTR decreased to 2.6 g/dl and 11.9 mg/dl, and CRP increased to 5.337 mg/dl on the fifth day. On the 7th day, TTR increased, and CRP decreased, although Alb did not improve. In SBDs, the median Alb and TTR decreased to 2.6 g/dl and 9.7 mg/dl, and CRP increased to 4.077 mg/dl on the fifth day. On the 7th day, Alb, TTR, and CRP did not improve. CONCLUSION: In acute stroke patients receiving leucine enriched BCAA dietary supplement, quick improvements in transthyretin and CRP were observed.

Feeding patterns and outcomes of enterally tube fed paediatric kidney transplant recipients.

OBJECTIVE: Many children with chronic kidney disease (CKD) exhibiting symptoms of poor appetite, gastro-oesophageal reflux and vomiting are reliant on enteral tube feeds (ETF) to achieve adequate nutritional intake. Following a successful renal transplant (RT), some of these symptoms may resolve and ETF then discontinued. There are only a few studies reporting the time taken to transition from ETF to complete oral feeding after transplantation. This study aimed to investigate the time taken to discontinue ETF following RT in children attending a large tertiary nephrology unit. METHODS: A retrospective review of medical and dietetic records between 1 January 2014 and 31 December 2017. RESULTS: The study included 20 paediatric renal transplant recipients (70% male) aged 1 to 17 years. Seventy percent discontinued ETF at a median of 6 (0-70) weeks post-transplantation. Patients had ETF from a median of 0.45 (0-10.8) years of age, for a median of 3.9 (1.1-10.9) years prior to receiving a transplant. Four (20%) were referred to the Feeding and Eating Disorder team at a median of 20 (2-44) months post-renal transplantation. Mean body mass index (BMI) Z-score of 0.43 at 12 months pre-transplant was found to be significantly associated with shorter duration of ETF post-transplant (r = 0.8, p = 0.001). CONCLUSIONS: Seventy percent of children stopped ETF by a median of 6 weeks post-renal transplant. A good nutritional status pre-transplant may reduce the duration of ETF following transplantation. Four children experienced behavioural feeding issues post-transplant and required further specialist support. Future multi-centre research is required to support these findings to provide a more robust indication of time to achieve full oral feeding. Graphical abstract.

An Evaluation of the Nutritional Value and Physical Properties of Blenderised Enteral Nutrition Formula: A Systematic Review and Meta-Analysis.

BACKGROUND: Although there are merits in using commercial "enteral nutrition formula" (ENF) compared with blended ENF, there is a growing preference for the use of blended ENF in many countries globally. However, the nutritional value and physical properties of blended ENF compared with commercial ENF may be limiting its use. We have not found any evidence of a meta-analysis on the nutritional value of blended diets in the adult population. AIM: The aim of this review was to compare the nutritional value, physical properties, and clinical outcomes of blended ENF with commercial ENF. METHODS: The preferred reporting items for systematic reviews and meta-analyses were used for this review. The search strategy was based on a Population, Intervention, Comparator, Outcome framework. The following databases; Pubmed, EMBASE, PSYCInfo, and Google scholar were searched for articles of interest using keywords, Medical Subject Heading (MeSH) and Boolean operators (AND/OR) from the inception of each database until 23 February 2020. The articles were evaluated for quality. RESULTS: Based on the systematic review and meta-analysis, four distinct themes were identified; Nutritional value, Physical properties, Clinical outcomes; and Adverse events. The findings of this review showed inconsistencies in the macronutrient and micronutrient values of the blenderised ENF compared with the commercial ENF. The results of the meta-analysis demonstrated that there were no significant differences (p > 0.05) between the blenderised ENF and the commercial ENF in relation to the fat and protein contents of the diets. However, the blenderised ENF was significantly lower (p < 0.05) than the commercial ENF regarding the energy content of the diets, with an overall mean difference of -29.17 Kcal/100 mL (95% CI, -51.12, -7.22) and carbohydrate content with an overall mean difference of -5.32 g/100 mL (95% CI, -7.64, -3.00). In terms of sodium, potassium, and vitamin A, there were no significant differences (p > 0.05) between the blenderised and commercial ENF, although significant differences (p < 0.05) were observed between the two diets with respect to calcium, phosphorus, magnesium, zinc, iron, and vitamin C contents. Furthermore, the blenderised ENF showed significantly higher levels (p < 0.05) of viscosity and osmolality than the commercial ENF. The significantly lower levels of some of the macro-nutrients and micro-nutrients in the blenderised ENF compared with the commercial ENF and the difference in the expected nutritional values may be due to the fact blenderised ENF is produced from common foods. Thus, the type of foodstuffs, cooking, and processing methods may lead to loss of nutrients and energy density. The deficits in the energy content and some of the macro- and micro-nutrients in the blenderised ENF compared with commercial ENF may have implications for patients' health and clinical outcomes. The clinical implications of the underdelivering of nutrients may include increased risk of undernutrition, including energy malnutrition, which could have a negative effect on body composition and anthropometric parameters, morbidity, mortality, length of hospital stay, and costs. For outpatient care, this could increase the risk of hospital re-admission and homecare costs. Additionally, the higher viscosity and osmolality of the blenderised ENF compared with the commercial ENF can increase the risk of complications, including tube blockage, and impaired delivery of feed, water, and medications, with significant implications for patients' nutritional status and health outcomes. CONCLUSION: The results of this systematic review and meta-analysis identified significant variability in the nutritional value of blenderised ENF compared with commercial ENF. Furthermore, the nutritional values of the blenderised ENF do not meet the expected recommended levels compared with commercial ENF and these may have implications for patients' nutritional status and health outcomes, including the effect on body composition, morbidity, mortality, hospital re-admission, and costs. Further studies are needed to elucidate the nutritional value of blenderised ENF on patients' clinical outcomes.

A Descriptive Study of enteral tube feeding among adults in an acute care tertiary hospital-patient selection, characteristics and complications.

BACKGROUND: It is vital to develop a better understanding of the use of different modalities for enteral feeding and its associated complications, given differences in funding support, community resources and infrastructure available to support home enteral feeding in an acute care tertiary hospital. AIM: To provide a description of the clinical characteristics of patients on long-term enteral feeding and incidence of associated complications. METHODS: A retrospective case records review study design was adopted. Medical records of patients discharged from a tertiary hospital with long-term nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG) feeding for the first time during the period of January 2010 to June 2017 were reviewed. Data collected include patient's demographics, reason for enteral feeding, morbidity and nutritional status upon initiation of NGT and PEG feeding, readmission episodes and documented complications (associated with enteral feeding) within one-year post discharge. RESULTS: Records of 120 NGT and 118 PEG patients were analysed. Significant age and gender differences were found with older patients being more likely to be placed on NGT [NGT (Mean 79.1, SD 11.3) vs. PEG (Mean 67.1, SD 12.6)] and higher number of females in the NGT group as compared to the PEG group (NGT 59.2% vs. PEG 31.4%). Majority of patients were fed by caregivers in the NGT (99.2%) as compared to the PEG (51.7%) group. Patients with cancer were more likely to be on PEG feeding (NGT 5%, PEG 70.3%), whereas patients with stroke-related diagnoses were more likely to be on NGT feeding (NGT 48% vs. PEG 8.5%). The total Charlson Comorbidity score was also significantly different between the NGT (mean = 5.7; SD = 1.5) and PEG (mean = 4.5; SD = 2.0) groups. A higher number of patients with PEG feeding had no complications (47.5%) as compared to the NGT group (8.3%). Patients who received NGT feeding were more likely experience tube blockage [OR 0.03, 95% CI (0.001-0.72), p = 0.03], secondary displacement of tube [OR 0.04, 95% CI (0.002-0.72), p = 0.03] and accidental tube removal [OR 0.03, 95% CI (0.004-0.21), p < 0.001]. CONCLUSION: Overall, patients who received NGT feeding experienced more complications than those who had PEG feeding. The choice for NGT or PEG feeding may be influenced by patient related factors as well as the presence of caregivers, which need to be considered in the improvement of enteral nutrition services in the local context.

Improving the experience of patients who receive home enteral tube feeding.

Home enteral tube feeding is an increasingly common intervention for patients who are unable to meet their full nutritional requirements. These patients require specialist support to enable them to live as normal a life as possible at home. An integrated acute and community nutrition service developed a new role of community nutrition nurse (CNN) in 2016, with the goal of reducing the number of unplanned hospital attendances relating to enteral tube feeding issues. Following the introduction of the CNN and related troubleshooting interventions, there was a 93% reduction in unplanned hospital admissions between 2017 and 2018. The role has been found to have many benefits, such as improved patient experience, care closer to the patient's home and empowerment of patients, their relatives and carers. It has also helped to increased patient and carer confidence to self-care and has reduced costs within the acute hospital system relating to unplanned hospital attendances and admissions.

Feasibility, acceptability of enteral tube feeding and self-insertion of a nasogastric tube in the nutritional management of digestive cancers, impact on quality of life.

No study has evaluated the feasibility of enteral tube feeding (ETF) in undernourished patients with newly diagnosed gastrointestinal (GI) cancer. OBJECTIVES: Evaluate the acceptability of ETF in patients unable to increase their dietary intake and with a weight loss >10% or albuminemia <30 g/L or BMI <18.5 before surgery, or a weight loss >5% during chemotherapy. The feasibility of self-insertion of a nasogastric tube was also assessed. RESULTS: A total of 308 patients were nutritionally screened during a one-year period. ETF was indicated in 123 cases. Overall acceptability was 78.9% and was higher when weight loss was >10% (p < 0.0001) and before surgery (p < 0.0001), lower during chemotherapy (p < 0.0001), while not influenced by dietary intake or location of the cancer. Forty patients managed a daily self-insertion of the feeding tube (45.5%) and 48 had a nasogastric tube maintained in place. All Quality of Life (QoL) parameters were significantly improved, notably physical role functioning (+20.9% ± 24.0, p < 0.005) and mental health (+21.0% ± 17.7 p < 0.005). CONCLUSION: According to the present algorithm, ETF was indicated in 39.9% of cases and accepted in 78.9% of newly diagnosed patients with primary GI cancer while improving QoL. This study strengthens the place of self-insertion of feeding tubes in clinical practise.

Japanese elderly individuals wish for enteral tube feeding more strongly for their parents than for themselves.

[Introduction] The purpose of this study was to investigate the differences in the preference of enteral tube feeding between elderly inhabitants of Mugi town, Tokushima Prefecture, Japan, and their parents in various physical conditions. [Methods] This population-based questionnaire survey studied 300 randomly selected participants aged 65-80 years. Respondents were to consider a situation where eating was difficult, and were questioned on their desire for tube feeding, using a visual analogue scale (VAS) ranging from "do not want tube feeding (0)" to "want tube feeding (100)." [Results] Valid responses of 103 (34.4%) participants were analyzed. Under conditions of being "healthy," "bedridden," "with dementia," and "bedridden and with dementia," the median (IQR) of the VAS values for the desire for tube feeding were 31.8 (3.3 to 83.8), 19.3 (2.4 to 52.3), 5.2 (0.7 to 18.9), 4.0 (0.3 to 15.2) for respondents and 55.2 (11.6 to 92.2), 48.7 (5.5 to 85.5), 9.0 (1.2 to 46.8), 5.1 (0.1 to 36.5) for parents, respectively. The VAS values for the parents were significantly higher (p=0.001, 0.002, 0.001, and 0.01, respectively for the four conditions described) for the same items. [Conclusion] Surrogate decisions made by family members often differ from what the patients would have desired. J. Med. Invest. 66 : 258-263, August, 2019.

Recurrent Hyperammonemia During Enteral Tube Feeding for Severe Protein Malnutrition After Bariatric Surgery.

A 28-year-old female was admitted 2 years after gastric bypass limb distalization because of severe weight loss, fatigue, chronic diarrhea, massive edema, and a serum albumin of 10 g/L without proteinuria. A diagnosis of severe energy and protein malnutrition was made, and enteral tube feeding was started in combination with pancreatic enzyme supplementation every 3 h. Within 24 h after the start of tube feeding, she developed severe hyperammonemia. Tube feeding was stopped immediately, and this led to a normalization of serum ammonia levels within 8 h. When tube feeding was resumed, albeit at a lower rate and with preventive measures taken, hyperammonemia occurred again. The underlying causes and treatments of hyperammonemia during tube feeding are discussed.

A Successful Percutaneous Endoscopic Gastrostomy Tube Feeding over Two Decades with No Complication: A Rare Case Report.

Percutaneous endoscopic gastrostomy (PEG) feeding is a common and widely performed procedure appropriate for long-term enteral nutrition in patients with multiple indications. We present the case of a 59-year-old woman with a PEG tube placed owing to complication following thyroid surgery approximately 20 years ago, representing the most extended duration of PEG tube feeding without any significant complication for chronic mechanical dysphagia. This case highlights the importance of PEG feeding, where this route can be used indefinitely in an appropriate clinical setting without complications. Interestingly, self-replacement of PEG tube was performed by the patient herself whenever she noticed clogging up of tube while self-feeding.