Blenderized Tube Feeding (BTF) is a growing trend where individuals use blended whole foods for tube feeding, driven by a desire for more natural and personalized nutrition. This presentation explores its prevalence, benefits, challenges, and practical implementation for both patients and clinicians.
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welcome everyone thank you for joining
us today for the Olli foundation webinar blenderize
blenderize
to feeding thank you again for joining
us my name is Andrea Guidi I am the
executive assistant for the Olli
foundation most of you are probably
familiar with the Olli foundation but
just in case this is your first
experience I'd like to briefly introduce
the organization the Olli foundation
strives to enrich the lives of those
living with home nutrition support both
intravenous nutrition sometimes called
hpn or TPN and tube feeding we do this
through education outreach and
networking the holy foundation was
founded in 1983 by dr. Lynn Howard and
her patient Clarence Olli Oldenburg
today we serve approximately 17,000
members all of our programs are free of
charge for patients and their families
first we'll go over a few housekeeping
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on your screen now for the presentation blenderize
blenderize
tube feeding btf is becoming a more
popular option for two fed patients both
adults and pediatrics lisa will discuss
prevalence of the use of btf as well as
discuss tools needed to blend at home
and how to create homemade recipes the
pre-made whole food formula
for both adults and pediatric will be
reviewed it gives me great pleasure to
introduce today's presenter we set up
Lisa is a registered dietitian
nutritionist at Mayo Clinic in Rochester
Minnesota she received her Bachelor of
Science degree from University of
nebraska-lincoln in 2003 and completed
her Dietetic internship at Mayo Clinic
in 2004 she is a member of the Academy
of nutrient and Dietetics as well as
American Society of ntral and parenteral
nutrition she is an assistant professor
in nutrition Mayo Clinic College of
Medicine and a home enteral nutrition
coordinator her interests include
enteral nutrition in pediatric and adult
patients blenderize to feeding and
speaking at state and national
organizations such as the American
Society of ntral and parenteral nutrition
nutrition
clinical nutrition week Academy of
Nutrition and Dietetics food and
nutrition conference and with the only
foundation we are thankful to have you
presenting today Lisa and I will turn
the presentation over to you now all
okay well thank you for that
introduction we have a lot to get
through today and I'm gonna do my best
to get through a lot of the questions
that were turned in ahead of time so I'm
gonna kind of go quickly through the
objective since you mentioned those
already and kind of delve right into the
first question that we have is who is
using blenderize feeding at home so
these are just some photos of some of
our patients we sent cameras home with
them and said show us what you do at
home because I bet it's different than
kind of the ideas that we're getting
which really opened our eyes to look at
you know maybe patients are kind of
coming up with things on their own at
home that we're not aware of so this led
us to our first kind of survey of our
own patients
to kind of ask them are you using
blenderize to feeding at home and our
survey was given to 30 of our home ntral
nutrition patients and of those 30
patients we found about 55 percent of
them said yes i'm putting something
other than commercial standard formula
water and medications through my tube
but the most important thing that we
learned is that 90 percent of them
express the desire to do blenderize tube
feeding if they had adequate information
to do so the other thing that we learned
from this survey is that of these
patients that responded they responded
when they used blenderize tube feeding
that they had no GI symptoms 83 percent
of the time and on a commercial formula
had no GI symptoms only 67 percent of
the time so that made us think okay well
commercial formula is at least or
blenderize tube feeding is at least as
well tolerated as the commercial
formulas that our patients are using so
we further ask them some more questions
and one of the questions was why are you
doing this and the most common response
was that they felt like it was more
natural and the reason why they weren't
doing it is because they weren't really away
away
of it so people looked at this survey
and said well your patients are pretty
savvy i bet more more of your patients
are doing home blend rice feeding than
maybe other patients out there so we
decided to provide the exact same third
survey through the Olli foundation and
got respondents both pediatric and
adults and we broke those into two
categories so for the Pediatrics we had
125 respondents and found that almost
90% of the people that responded to the
survey were getting blender ice tube
feeding for an average of 71 percent of
their daily calorie intake and
seventy-five percent of them were making
homemade blends and 25 percent were
using a commercial blender ice product
one thing that was important that we
noted here is that 90 percent of the
pediatric patients were not losing
weight when they were using the blender
ice formula compared to around 59
percent said that they weren't losing
weight so quite a with commercial
formulas so quite a few more kids not
losing weight with the use of blender
eyes feeding so then we looked at the
adult population and again
Oly foundation savvy consumers expected
there to be a higher percentage of
respondents using blender eyes feeding
and here we see obviously less than in
the pediatric group so 66 percent of the
adult patients that responded said they
were using blender ice tube feeding for
about 50 percent of their daily intake
but quite a few more were using some of
the commercial blender ice products only
67 percent were using homemade blends
and kind of the same trends here you
know reporting less weight loss with the
use of blender eyes feeding versus
commercial formulas so when comparing
those statistically there was a
significant showing us that using
commercial entró formula was more likely
to lead to weight loss than using
blenderize formula so we looked at those
two surveys the Mayo patients and the
Olli patients both pretty savvy savvy
groups and said okay but we want a
bigger bigger broader population of
respondents and so we were able to get
about 1,500 respondents to the same
survey and this time it was linked not
only on the Olli Foundation website the
feeding tube awareness foundation
website but also quorum and pediatric
home services to home medical equipment
companies helped helped us get the word
out about our survey to some of their
patients that might not be part of one
of the two groups that I mentioned which
allowed us to get a lot bigger
population but also hopefully a little
bit broader population and when we broke
to those two groups the pediatric group
reported about 24% using blenderize tube
feeding and the adult group about 15%
which we feel is probably closer to kind
of those averages that are happening out
there in the general population this was
presented as an abstract at clinical
nutrition week a couple weeks ago
however we have thousands of data points
that we learned from this survey that we
hope to publish in the very near future
so kind of looking at that that tells us
ok peep people are definitely doing
blenderize feeding at home both
pediatrics and adults so the takeaway is
that really for the clinicians that we
might be losing our patients if we're if
we are refusing to help create recipes
because they might be going to non
clinicians or just trying to figure out
on their own how to create home blended
recipes so I really would encourage this
to become part of a nutrition assessment
where you're asking okay you told me
you're taking X formula this amount of
water these medications do you put anything
anything
through your feeding tube like smoothies
or blended fruit or Gatorade or anything
like that just to get the story started
and help build that rapport when we
start those cameras that I mentioned
home with our patients um these were
some of the responses that we got back
you have brought the joy of cooking back
into my life I really like it it makes
me feel more normal I have more energy
with blenderize feeding and more regular
bowel movements and I have felt the best
I have in 10 years so when you're
hearing responses like that from
patients it's really difficult for us to
say no you cannot do this so what is the
appeal I think the general population is
really looking at our food supply and
they're wanting to look on labels for
ingredients that they can understand and
ingredients that they probably have in
their own kitchen they're wanting
personalized nutrition maybe avoiding
certain ingredients or allergens using
cooking for their family member as
nurturing or being able to feed their
family member the way that the rest of
the family eats whether it be vegan
organic non-gmo
or tomatoes from the garden in summer
families are wanting everyone all of
their loved ones to get that kind of
nutrition so let's talk a little bit
about the clinical benefits we're going
to talk a little bit about food allergies
allergies
some of the GI benefits in terms of
improved reflux bowel regularity bowel
abdication and the gut microbiota which
is kind of one of those hot topics in
nutrition right now
but also I cannot stress enough the
building patient rapport kind of those
looks of what are you doing and why are
you doing this and I don't want you to
do this still happen and that's
understandable because we're still
learning however really encouraging you
know providers and clinicians to be open
to hearing what is it that your patient
or family member once out of out of
their nutrition so let's start with the
GI and tolerance
studies so kind of the first study that
ever really showed us part of you know
increasing or improving symptoms with
using formula with real food ingredients
was in which thirty-three children who
are given blenderize feeding and you can
see here that they had a reduction of
gagging overall GI symptoms improved no
child had worsening symptoms and it
really did lead to increase oral intake
so really what we're looking at with
some of these studies is you know
studies that have gone through the peer
review process and that were done on
large groups and you can see as I go
through these these are very small
groups so even though we do have some
studies they are they are small and and
we're still hoping for those large
randomized control trials to to help us
make more clinical decisions so kind of
moving through these the next study that
I'll talk about here is with ten
children who had a mean small bowel
length of about forty eight centimeters
and they were given formula with real
food ingredients and nine of the ten
children were able to transition off an
elemental formula hand and had an
improvement of schooling which in this
case meant less diarrhea easier to
control hydration and the last one I'll
mention here was a group of 18 infants
that had diarrhea that were randomized
to either blenderize to tube fitting or
a semi elemental formula and in the
group that were given the blenderize
tube fitting diarrhea was better and
those infants had better weight gain
than the ones that had the semi
elemental formula so again small studies
but they are kind of all we have right
now so moving on to a pilot that we did
here with adult patients nine patients
were given blenderize tube feeding their
GI symptoms in this population were
similar to those who were on commercial
formulas none of the patient had a tube
site infection or symptoms of foodborne
illness and those with the normal BMI
gained weight a few of the patients with
the BMI greater than 30 did lose weight
but that was intentional this last study
was one that I was not as familiar with
that I came across more recently which
actually was not even a study about
blenderize tube feeding it was a study
about looking at the gut microbiome of a
group of elderly who were living in a
long-term care facility and so the
researchers looked at stool cultures of
178 elderly and they really put them
into two two groups based on what their
intake was and what they found was that
there was a much healthier diverse
amount of good bacteria in patients who
had a varied diet who ate well who had a
variety of foods and that the group that
were on a single formula every day had
the least amount of healthy bacteria in
their gut and the researchers concluded
that a single formula could contribute
to long-term ill health and the elderly
because it was not adequately feeding
the gut microbiome so what is the
hesitation and I think you know even in
our schooling those dietitians we were
taught some of these things and so it's
kind of what's on our mind is is this
something that is even safe so the first
one is microbial contamination there
have been some publications that talk
about you know hospitals that are using
blenderize to feeding and having a very
high amount of bacteria in their
formulas but a couple things I would
like to point out about the studies that
are published they were in hospitals
where the temperature is 80 to 90
degrees Fahrenheit and they do not have
air conditioning 98.6% of the blender
ice to feeding formulas actually had
unacceptable levels of contamination at the
the
time of preparation so you can imagine
bacteria did increase after being in the refrigerator
refrigerator
however the refrigerator was kept at
forty eight point eight degrees
Fahrenheit and we know that less than
having you know having our refrigerator
at around forty degrees is is more
conducive to decreasing bacterial growth
but even with this amount of
contamination and bacteria there were
actually no cases of patients getting
ill from contaminated formula and there
aren't any studies that I'm aware of
that show that patients actually got ill
from having increased microbial
contamination in their formula so again
you know we hear about these the safety
and the food safety but we do really
need to look at the specifics of the
research done to know how applicable
that is to our practice especially when
you live here in the freezing cold when
it's negative ten degrees today there
are limited peer-reviewed publications
about the use of blender ice tube
feeding and like I mentioned we are
really hoping to increase the literature
with some randomized controlled trials
however one could argue why do you need
studies to prove that food is healthy
for people I think we've proved that
orally that a variety of foods are
healthy for people and so I think that
is leading to decreased number of people
wanting to research this because they
feel like we've already done that we've
already proven that food is healthy for people
people
another hesitation for a clinician would
be that we're not exactly sure what's in
those you know homemade blenderize
products and we want to make sure our
patients are getting good nutritional
balance and so how would we accomplish
that if they were making their own food
at home increase increase in clinicians
time definitely as a hesitation
especially when you don't have
a lot of experience however I think the
registered dietitian nutritionist guide
to homemade blender ice feeding that the
Academy of Nutrition and Dietetics put
out in 2016 is very very helpful and
also an indicator that our own Academy
is encouraging us to learn more about
how to help people with blenderize
feeding potential for increase in costs
or losing reimbursement of enteral
nutrition supplies may be a hesitation
tube clogging to wearing out more
quickly is a hesitation and it may be
more difficult to travel lastly you know
if you have a child or you yourself or
somebody who goes in and out of the
hospital and you don't have a hospital
that supports blenderize feeding that
makes it hard to do blenderize feeding
at home and then having to go to use
something differently different while
hospitalized so here are some criteria
that kind of we recommend before
realizing if blender ice tube fitting
this for you so definitely talking with
your primary care provider or your
child's primary care provider that this
is something that you are interested in
we recommend our patients have a mature
stoma though this isn't set in stone and
the reason for that is because if we
happen to get a tube clog in those first
six weeks after a tube is placed it's
much riskier to have to change the
feeding tube then it would be if the
tube has been in for three months and we
accidentally don't blend an olive well
enough and that clogs up the tube it's
much less risky to change the tube after
that time 14 French or greater tube
however smaller French sizes may work
with some of the commercial formulas
which we'll talk about here in a minute
and if you thin out the home blends
smaller French scientists would work it
just would increase the volume needed so
for anyone who's volume sensitive a
smaller French size may be prohibited
having a system in place
monitoring so just like with any change
we want to make sure that after we make
that change we follow up to see how it's
going making sure that there aren't any
adjustments needed along the way having
adequate of equipment available so when
I have somebody come into the office and
say I want to start blenderize tube
feeding that visit is really a planning
visit and then I really encourage them
okay now you need to go get your blender
go get your food you know come up with
some sample recipes together and then
come back and talk about implementing
that so kind of having that good
preparation ahead of time and then
having a nutrition professional
professional available to help you with
making recipes is also recommended so I
just want to talk briefly about Hospital
blenderize feeding because this was a
few of the questions that came in ahead
of time and we do actually have a
protocol for using blenderize feeding
that could be its own whole hour
dedicated to that but I just want to
kind of give you a few of the bate
basics the first part of the protocol
really talks about first of all is it
safe to use blenderize to feeding in
this patient so we do not allow it to be
used for critically ill patients in the
ICU just because you know we wouldn't
send a piece of pizza up to the ICU for
a patient to you know was not
hemodynamically stable which can
increase their risk for bowel ischemia
or bowel perforation if they're getting
especially fiber in their tube feeds so
that's one of the things that we kind of
look at though you know we have our you
know kids who get bone marrow
transplants that are in the ICU for
three months yeah we definitely still
let them use blenderize feeding there so
it's really looking at you know their
stability and how ill are they and would
it be safe to give whole foods to the
patient we also prefer not to start
blenderize feeding in the hospital just
because logistically it is
difficult to come up with a whole plan
in a hospitalized setting we prefer to
do that in the outpatient setting if
those two things are not issues then
normally what we do is use the patient's
home home program so we have room
service here in which patients call down
and order their food and we have a
pureed menu and so for example if I was
calling down for my child I would call
down and say I'm calling to order
blender ice tube feeding from the pureed
menu and I would like puree chicken
pureed green beans bananas yogurt and
whole milk for my child's lunch that
then actually goes down the tray line
which already has a system in place for
monitoring food temperatures food
preparation and food safety and at the
end of the tray line we have a
commercial grade blender that all of
those pureed products go into and then
it's put into a jug similar that we use
for our mixed commercial formulas and
sent up to the patient's room on the
tray exactly the same way a tray is sent
if a child or a patient is eating orally
that really allows us to keep within our
food safety parameters monitoring
parameters and nursing notes Oh a tray
is here that means I need to really make
sure my patients going to get their meal
in the next thirty minutes or I need to
refrigerate this so we have really
chosen to look at our home blender ice
or our blender ice feeding in the
hospital as a tray rather than a mixed
formula but we have also decided to have
a commercial blender ice product on hand
so patients can use that in the hospital
because if the patient or caregiver
can't administer the blender ice feeding
themselves or they can't order it themselves
themselves
nursing really isn't able to call down
make up recipes by ordering their food
and then sit at the base patients
bedside for 30 minutes administering the
feeding so that is
why we have the commercial blender ice
products as a back-up plan another
question that I had had was about post
pyloric feeding and our preference for
post pyloric feeding is that we use a
commercial blender ice product and it's
mostly because of the hang time of food
which I'll talk about here in a minute
but it's two hours so homemade blender
ice tube feeding should not be at room
temperature for greater than two hours
and if we have to use a pump to
administer that it just gets really hard
to be compliant within that two hour
hang time however I will say that some
patients do tolerate bolus feeding into
their small intestine especially those
that have had gastric bypass surgery or
maybe an esophageal me where they've
already been used to eating orally
without a stomach they may be able to
tolerate some bolus blenderize feeding
into the small intestine but definitely
more experience and some research is
needed here to look at can we put
blended chicken directly into the small
intestine and can can patients digest
and absorb that are there certain
patients that can are there some that
can't does it take more time to get
tolerant to that so those are really
questions that I just unfortunately
can't answer yet so we talked about some
of the tools that will be needed having
a nutrition professional available
having a plan in place getting your
supplies ready prior to the day that
you're gonna get started on blender ice
feeding so some people will ask what is
the best blender and we did actually
test a variety of blenders and found
that the Vitamix does seem to blend
especially thicker flute foods better
than any of the other ones that you see
there that we tested however the ninja
system really came in a close second so
when you look at
cost sometimes that ninja might be a
more reasonable option for patients but
what we did find is that increasing how
long we blended the food did make those
less powerful may be less expensive
blenders work a lot better at increasing
or you know blending the food better oh
ring syringes seem to work best for
bolus feedings because they don't get
sticky and are easier to push using a
straight extension set for the low
profile tubes instead of the right angle
so the food doesn't have to go around
the corner so a couple of other things
about supplies I did get quite a few
questions about how do you use a pump
with blender ice feeding and really what
I have to say here is that the
manufacturers of feeding pumps have said
that their pumps should not be used with
anything except for commercial formula
therefore if you're using a pump for
homemade blenderize feeding you're doing
so at your own risk now I will tell you
that I did learn at clinical nutrition
week that the new kangaroo Connect is it
was not made for blenderize feeding but
they feel like it may be easier to
administer blender ice feeding because
there's going to be less pump alarm as
there's different on particle sizes
within the formula so I would kind of
possibly look into that option the other
thing that I will mention about pumps is
that the accuracy of the pump definitely
changes once you put whole food into the
feeding bag so I've referenced here a
poster from Clinical Nutrition Week but
they really am testing some of the tubes
found that blenderize formula had
between a 17 and 88 percent accuracy so
17 percent accuracy is not very high
which means you know your patient is
going to be really need to adjust
their rate at home based on their daily
volume not based on Mills per hour
because it seems like those thicker
formulas aren't as accurate when using
gravity bags the large for gravity bags
seemed to work better we mentioned the
syringes and then again perishable food
should not be left out at room
temperature for more than two hours and
one hour when the temperature is above
90 so we really give three ways to make
recipes the first one would be with
exchanges the second would be to use a
standardized recipe where though I don't
really recommend that very often and the
last one would be plate method or using
the family meal so let's look at the
exchanges so this is a sample 500
calorie recipe that would be a good
combination of protein carbohydrate and
fat and would contain food from each of
the food groups the nice thing about
this recipe we've used this for a lot of
different blender ice to feeding
patients is you can double it triple it
quadruple it half it and you still have
a nutritionally complete product that's
not too high in fruits and has no meat
or has too much protein and not enough
carbohydrate so it's a good way to
really make sure that you have the right
amounts of each food and again you can
double it triple it quadruple it for
whatever calorie level you're looking
for this would be an example of a
standardized recipe that we do have in
our hospital so if someone didn't want
to call down and order a meal and they
say oh yeah I'm a I'm a big guy I'm
going through rehab and my lung I like
my meals to be about a thousand calories
do whatever you want with it this would
be an example of a recipe that we would
make using the food entree line and send
it up on a lunch tray this is really the
method that I prefer when it comes to
building blenderize recipe
so if you go to the choosemyplate.gov
website it gives you a variety of
calorie levels and at that calorie level
it tells you how many servings of each
food you would need to come up with a
nutritionally complete recipe now a
couple things that I will mention about
this I do recommend that people season
the foods the same way they would if
they were eating them because blenderize
feeding can get low in sodium potassium
and other micronutrients so for example
if someone is making green beans I would
say if you would normally put butter
salt and pepper on green beans for your
family you would put butter salt and
pepper on your green beans for your
family member that's going to be using
this and to feeding it's a good way to
make sure that you're getting enough
salt but also just treating this just
like food that we would be eating by
mouth here are some examples of foods
that blend well that can be used in each
food group and it kind of gives you an
idea the fat for example of what counts
as a serving of fat so 1/2 a teaspoon of
oil 1/2 a tablespoon of butter or 10
olives could all be counted as one fat
serving so just to give you some idea of
some foods that do blend well I kind of
gave you each of those in each category
so some of the things that do come up in
kind of short comings for recipes that
people make so sometimes I get a consult
and somebody comes in and says I've been
doing blender ice feeding for the last
couple weeks and I just want you to look
over what I'm doing and help me tweak
that I say the number one thing I
probably get is people using too many
fruits and vegetables because they get
so excited about using healthy foods
that they might overdo it with fruits
and vegetables which then just doesn't
allow enough room for the other things
their body needs now if volume is
an issue they can use as many fruits and
vegetables as they want I think using
protein powder ends up being a little
bit of a short coming as well you know
sometimes people have this idea that
they need a lot of protein and we do
need protein but a lot of times that can
be met with beans and tofu and milk and
animal products as well so a lot of
times protein powder wouldn't be needed
I mentioned about the salt and potassium
just making sure that we're seasoning
our food but sometimes we do need to add
salt and that would be kind of decided
with your healthcare provider sometimes
patients forget to put carbohydrate put
too much water or not enough water so
when we look at monitoring these
patients it's really the same as all
other and truly fed patients so if you
look at the Aspen practice guidelines
there isn't really a strong
recommendation for routine lab
monitoring for entirly fed patients
there's not a recommendation for giving
a daily multivitamin unless you know
that the patient is not meeting their
vitamin and mineral needs so our our
protocol for monitoring is just a
supplement as needed and so if someone
is not getting adequate calcium of
course we're going to give them a
calcium supplement but if they're
getting 3 cups of milk a day in their
blends we're not going to give them a
calcium supplement so I just want to
touch briefly on some of the products
that are out there for commercial
blender iced product this is meant for
information only and not to promote any
of these products and most of the
information I have on the slides was
taken from the company websites so
here's a list of the current products
that I am aware of that contain blender
ice food or real food ingredients that
are on the market the last one ultra int
I don't have a lot of information about
all's I know is that it's a product
that's going to have P and rice and it's
going to come in
bag already that actually connects
directly to a feeding tube and then it
might be coming out in the next few
months so I don't know much about that
one but we'll talk about that other four
groups so what are some pros of using
the commercial blender ice products its
precise you know exactly what is in
there in terms of micronutrients and
macronutrients it's convenient it's
already made and it has a more
consistent viscosity so you're not
worried about how much fluid to add the
cons is there aren't a lot of
peer-reviewed publications
about these products they're just new
and it takes time to do the studies and
get them published and go through the
peer review process so we don't have a
lot there possibly decrease the pump
accuracy like I mentioned could be
difficult to get insurance coverage just
because the codes are more of specialty
codes though I have definitely seen a
big improvement in a variety of
insurances Medicaid Medicare and private
insurances covering these products and
supply your availability not knowing
where to get them again this has
dramatically improved as well and and
we're able to find these products at a
lot of our home medical equipment
companies now so starting with real food
blends you can kind of see some of the
specs here but I'll just point out a
couple of the the main points when
looking at real food blends are really
meant for both kids and adults but it's
just food it doesn't have any vitamins
or minerals added to it so it's not
considered a quote complete nutrition
product however if my child was eating
salmon and oats and veggies for dinner
I'm not sure that I wouldn't not
consider that I'm complete and so I
think that can be taken just per
clinicians experience the other thing to
know about this is it does have an only
a two-hour hang time so again you would
not be wanting to water it down putting
it on a pump and letting it run for 12 hours
hours
so nourish and liquid hope again you can
look at some of the specs here so some
pros here is it has a 12-hour hang time
so easier to put on a pump has its
nutritionally complete there are
specific products for adults and
Pediatrics to better meet their vitamin
and mineral needs and the con that I
feel like there is is there's no fruit
or fruit juice in the product and just
something that we want to encourage a
variety of fruits but definitely
anything could be added into that
product as well complete and complete
pediatric this is a reformulated version
of formula that's been on the market for
a long time however these are from real
food ingredients and not blended whole
foods so the consistency is thinner and
may not give as much of the benefit when
it comes to that you know bowel you know
that will consistency reflux
regurgitation things like that but one
of the positives about it is is it can
be actually used in eight French tubes
or greater and can be used with gravity
or pump without dilution so it could be
used in nasal tubes a new product that
will be coming out complete organic
blends you can see kind of there's an
adult and pediatric version here it's a
blended to feeding product from whole
fruit whole foods not whole not food
ingredients nutritionally complete
compatible with pumps will have a
12-hour hang time but you do need a 12
French or larger tube and it would be
difficult to use this product with
gravity feeding because of the viscosity
so it might need to be thinned down if
you were using it for gravity heat farms
products there's a couple of them which
I'll mention on the next slide but you
can see they're compatible with pumps
they have a 12 hour hang time
nutritionally complete
but again they're made with food
ingredients not blended foods and so the
consistency is thinner than some of the
other products I mentioned so they have
their complete product which is meant
for oral intake it could be used as an
oral supplement or as sole source of
nutrition they have their core
essentials which is kind of their
standard tube feeding formula and they
have their peptide plus 1.5 which is
made from hydrolyzed pea protein as well
as MCT oil from coconut and again that's
in one of those specialty category
formula categories that we might need
extra documentation to get that covered
by insurance so kind of looking at some
of the things in between that you may
not think of blender eyes feeding would
be things like alcohol through a feeding
tube coffee smoothies
you know birthday cake on their birthday
seasonal foods Gatorade Powerade things
like that those are things that can make
they'll make people feel like they are
having more control over what's going in
their body as well so I want to allow
enough time for questions so I'm gonna
go through these slides on nfit very
very quickly so we can try to have at
least 15 minutes for questions so we
have done a couple of studies on the
flow of blenderize feeding through the
new and fit connectors as well as the
force that it would take to push feeding
through the new ntral connectors so this
was the initial study that we did it was
published in 2017 however what we did is
we took six ntral feeding formulas and
we put them through a syringe with both
in fit and our current feeding tubes
which we'll call legacy and we found
that it would definitely take longer to
push some of the thicker more viscous
formulas so from 15 minutes now with the
legacy tube up
maybe 30 to 40 minutes with the new mfit
tubes however these were done with
prototypes so we were able to then
obtain all of the different and fit
tubes that are currently on the market
as well as their version of the current
legacy tubes and ntral feeding was
simulated with gravity gravity feeding
and we found that there was no
difference if you were gravity flowing
with the syringe or a gravity bag there
is no difference between with the
low-profile tube the 18 French tube or
the 20 French tube a standard 14 French
tube and 24 French tube did have a
slower flow rate with enfant however one
thing that's difficult to interpret here
is everyone's homemade blenderize tube
feeding is so different that it's really
hard to know if you had a 14 French tube
would your recipe be different so that
was kind of a limitation to the study we
did additional testing then using the
force of a syringe to see would it take
more effort to push that viscous formula
through the tube and we definitely found
that viscous formula may be difficult to
push however it would be dependent on
what blender was used how long the
formula was blended what is the
viscosity you know people do so many
different things with their home blends
it's really just important that we're
going to be monitoring people closely to
make sure that you know this change does
not decrease compliance with how much
tube feeding they're giving because it's
taking more time so in conclusion it
does seem like a lot of patients are
starting to use blenderize feeding we
can definitely meet the nutrition means
of these patients especially with the
help of a dietician
for patients who are syringe feeding
there does not seem to be a lot of
difference between enfant and legacy
tubes but again depending on how you
prepare your home blenderize feeding
patients are definitely going to need to
be monitored closely and if their
gravity feeding we're gonna really want
to monitor them closely if they have a
thicker formula to make sure that it's
still able to go through the tube and
doesn't need to be modified in any way
to allow them to still get blenderize
feeding at home so with that I will open
it up to questions and hopefully we have
enough time to answer as many as we can
great Lisa thanks so much great job
incorporating a lot of information into
a short time that we had now begin the
question-and-answer session if you
haven't already done so feel free to
submit your questions in the question
section of the tool bar on the right
side of your screen we've had a lot of
questions come in so we're going to do
our best to get to as many as we can and
lisa has generously offered to answer
the questions we don't get to and those
questions and answers will be available
on our website so let's start with we
have one coming in can patients new to
tube feeding who will need to feeding
only for a short time during cancer
treatment successfully use blenderize
tube feedings I would say yes and this
is a large portion of our of our
patients that are using blenderize
feeding so I had mentioned that we
prefer the stoma to be mature before we
do blenderize feeding however you know
that's just a guideline and if someone
is going through chemo and radiation for
head and neck cancer we're definitely
willing to work with them to kind of
troubleshoot and find a recipe that
works for them however we do recommend if
if
possible for them to have some kind of
commercial formula whether it be blender
eyes or non blender eyes as a backup
just in case it's a day where they don't
feel good or a meal where they don't
feel good and they don't feel like
blending we want to have something to
fall back on great how important is it
to let a patient taste food before
feeding it if they are a hundred percent
too thin hmm that's a great question
we don't normally have you know worry
too much about patients tasting food
however an infants who have not had
exposure to any food before we do the
same thing as you would for an orally
fed child so offering for example baby
food green beans for three days through
the tube as a way to say kind of say
okay no reaction in green beans and then
trying to do that with five to ten foods
before we start to build recipes to make
sure that there aren't any allergic
reactions great we have another one
coming in how can I get enough calories
in such diluted food so one of the
things that we have tried to do is not
include water in our blends so trying to
use liquids that have calories and
protein whether it be heavy whipping
cream or soy milk you know using fruits
that have more fluid
to get our fluid intake rather than
diluting with water but then also really
falling back on those calorie dense
foods for example Grape Nuts you can get
a lot more calories out of a small
volume than you can for example pasta or
you can get a lot more calories out of
raisins than you can out of grapes so
when we need a lot of calories in a
smaller volume we like to use more of
those calorie dense foods you know using
oils and things like that
great any suggestions to avoid
coagulation of blender eyes to feed for patients
patients
come to beating so one thing I have kind
of learned is that normally the blend
needs to be reflected right before youth
so even if it's a family who blends the
night before for their meals for the
next day that normally the amount that's
going to be fed at that time either with
an immersion blender that you can just
kind of stick into it and blend it up or
actually putting it back in the blender
but I don't think it works very well
just to take something straight from
their freezer to the refrigerator to
thaw right to feeding usually you do
have to reblogged it okay great thanks Lisa
Lisa
how do you ensure patients are receiving
the correct vitamins in minerals when
using homemade blenderize diets so if I
am worried about it I will use a program
like nutritionist Pro to put in what
you're utilizing so I can see exactly
what what micronutrients they're getting
however if they're using the myplate.gov
and getting all the recommended serving
fruits and veggies and grains and and
healthy fat protein sources I really
don't kind of calculate those things
just because we wouldn't calculate those
and in people who are eating as long as
they were eating a variety of foods so I
only do that in a program when I'm
worried that they're not getting a
variety of foods or if their calorie
needs are very low that it would be
difficult to meet their vitamin and
mineral needs with a small amount of
food okay great Lisa what are the best
carbohydrates protein fat sources to use
in blenderize to feeding in terms of
ease of provision and mixing so the
slide that I had that kind of showed
that list of what what mixes well would
be a good reference but for example
carbohydrates what I have found is that
like toasted bread blends really well but
but
piece of bread that's just fresh made
kind of just don't you know balls up or
dough's up so something that's a little
bit crispier that can be dissolved
definitely blends well I have found that
brown rice blends easier than white rice
because white rice kind of gums up as
well in terms of protein sources
I really haven't found a protein source
that does not blend well and then fats
you know again most most fat sources do
blend well one thing that does take a
little bit of extra power would be like
seeds if you were going to use a whole
seed or something like whole olives then
I just recommend that you have you know
a high-powered blender but there's
definitely foods in each of those food
groups that are easy to blend and like I
said I would look at that slide that I
gave a few examples okay
and again these slides we will have
available on our website so people can
refer back to them Lisa what resources
would you tell families to use to create
recipes for blender izing their own foods
foods
I really like the myplate.gov
super trackers I really like the calorie
levels that are set there and then they
give you at each calorie level the
amount of fruit and veggies and protein
and all of those things that are needed
it's a government source so I feel like
it's a reputable website that gets
updated regularly so that's one and you
know I have used some of the recipes in
the homemade blended diet handbook which
I think I have referenced at the end of
my slides but I will say that is
something that is lacking is how how to
build recipes so I think it's lacking
because clinicians are hesitant to put
some of that information out there that
can just be used by everyone that you
really would want to be you know meeting
with a dietician or healthcare
professional that's comfortable and
helping build recipe
because each each patient is so
different that having some of those
standard recipes you know might be
harmful great I have two questions
together how do you typically get
someone started with blender izing and
how do we get our nutritionist onboard
with blended diets mm-hmm so normally if
someone's on like all standard
commercial formula we'll start by saying
let's choose one meal for example let's
choose breakfast and come up with a
recipe for that in general I think
taking 25% of their daily intake and
trying to convert that to blender ice
feeding first but what ends up happening
to at least me and practice is that we
end up starting with blender ice snacks
so for example if they're on three meals
a day of commercial standard formula and
they're still losing weight or still
feeling hungry I feel like okay this
would be an opportunity to say let's
take some yogurt and a banana and blend
that together for a snack you know
mid-afternoon snack how do you tolerate
that do you mind the work of blending
you know do you feel good with that and
if they like that or you know an evening
snack or something then we might start
to transition meal by meal but in
general I think if you look at the the
registered dietitian nutritionist guide
to homemade butter to blender ice to
feeding on the Academy website they
recommend starting with 25 percent of
calories and transition and then slowly
go up from that and then getting your
nutritionist onboard I think one thing
that would be helpful is just sharing
some of their resources that I have on
my slides especially ones that are from
Academy and nutrition and dietetics and
from American American Society of ancho
and parental nutrition because those are
really our kind of governing bodies and
where we go to for information so I kind
of feel like if if they're putting out
information of how to do blender ice feeding
feeding
then you know that makes me more open to
wanting to do it because obviously my
Academy is giving me resources to doing
that great we have one coming in best
practice for present of preventing flow
errors when using blenderize food yeah
there was a lot of questions ahead of time
time
on this and I hate to answer questions
this way but really what I have to say
is you shouldn't be using a feeding pump
for homemade blender ice eating because
they're not really meant for that I know
that there are there is information out
there about how to modify pumps and how
to modify pump tags but as a clinician
those are harder things to support you
know I'm looking forward to potentially
a company says that they're working on
creating a pump for blenderize feeding
and and hopefully that will help solve
some of these issues that we're having
great and we have time for one more Lisa
what are some coping strategies for
blenderize folks who are traveling
I'd like yes yes yeah I think well a
couple of things number one having
having a blender that you can travel
with like an immersion blender makes it
a little bit easier than carting around
you know a large blender however I
really do feel like having you know this
is a great place for having a commercial
blender ice formula as a back-up plan to
say you know I can just open a cartoon
or I can just open a pouch and do that
on the plane you know I'm on an eight
hour plane ride because really how would
you keep home blended feeding you know
at proper temperature keep it from
coagulating keep it stored I really I
really think having some of those
commercial products as a back-up plan is
really helpful when it comes to
traveling that's great thanks so much
Lisa we do have
a page here on the only website where
you can find all our resources for
blender eyes tube feedings and thank you
to Lisa for an excellent presentation
today we appreciate you sharing your
expertise with us many thanks to halyard
for supporting this important
educational program thank you also to
participants for joining us today we'll
post a recording of the presentation on
the Olli website in case you'd like to
view it again we hope you will join us
for another webinar to view our schedule
of upcoming webinars and past recordings
visit the Olli website at Olli org slash
webinars and that is it for today thank
you all for joining not us and have a
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