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Chu HS, Lee H. YouTube as a possible learning platform for patients and their family caregivers for gastrostomy tube feeding: A cross-sectional study. Nutr Clin Pract 2024. [PMID: 38958580 DOI: 10.1002/ncp.11186] [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: 04/26/2024] [Revised: 06/06/2024] [Accepted: 06/15/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Many patients and family caregivers have informational needs, especially regarding gastrostomy care and home gastrostomy tube feeding. YouTube is a potential accessible option for educational resources concerning these topics. METHODS This study aimed to explore the educational quality and content of informational YouTube videos. We used "gastrostomy," "G-tube," "enteral feeding," and "enteral nutrition," as search keywords on YouTube on October 3, 2021. A total of 229 videos were evaluated using the global quality scale (GQS) and modified DISCERN scoring system. Variables extracted from the videos included general features, video parameters, and content themes. RESULTS The GQS and modified DISCERN scores were 3.31 ± 0.90 and 2.63 ± 1.23, respectively. There were educational quality and differences among videos uploaded by various agencies. Frequent video content themes included "cleaning and dressing a gastrostomy tube," "bolus method," and "replacing a balloon-type of gastrostomy tube." CONCLUSION Results showed that YouTube can be a supplemental educational resource for people requiring gastrostomy care and for their caregivers. However, given the open-access nature of YouTube, healthcare professionals' guidance is needed for video selection. Healthcare professionals should know and use specific, reliable resources to effectively guide and educate patients with gastrostomy and their caregivers, enhancing their self-management skills and knowledge.
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Affiliation(s)
- Hyeon Sik Chu
- College of Nursing, Dankook University, Cheonan-si, Republic of Korea
| | - Hanyi Lee
- College of Nursing, Hanyang University, Seoul, Republic of Korea
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Mohamed Elfadil O, Patel A, Joly F, Lal S, Bozzetti F, Cuerda C, Jeppesen PB, Van Gossum A, Wanten G, Szczepanek K, Lamprecht G, Vanuytsel T, Pironi L, Hurt RT, Mundi MS. Patients' and caregivers' perspective on challenges and outcomes with tube feeding: Analysis of home enteral nutrition survey data. Clin Nutr ESPEN 2024; 61:94-100. [PMID: 38777479 DOI: 10.1016/j.clnesp.2024.03.005] [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: 09/22/2023] [Revised: 02/06/2024] [Accepted: 03/02/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Given the growing use of home enteral nutrition (HEN), assessing the experience of consumers and caregivers is crucial to understanding the real-world subjective and objective challenges of administering HEN. METHODS After obtaining institutional review board approval, a survey was distributed to HEN consumers and caregivers between January 16, 2020, and July 16, 2021. Data collected included information regarding demographics, primary diagnosis, tube and connectors, HEN regimen, and overall HEN experience. RESULTS A total of 884 individuals responded to the survey: 673 (76.1%) responses by caregivers and 211 (23.9%) responses by patients. The study cohort included 566 (64%) children and 318 (36%) adults. The leading primary diagnosis of participants was developmental delay and motility disorder for children and adults, respectively. Low-profile gastric tubes were the most used (75.7% of children and 30.3% of adults). Notably, legacy connectors were utilized for more patients (46.7% children, 52.6% adults) compared to ISO-80369-3 connectors (38.9% children, 29.7% adults). HEN complications were prevalent, including enteral tube site infections and other tube-related complications, including clogging and kinking. CONCLUSION This real-world data reveals that HEN complications remain prevalent. Additionally, despite introducing ISO-80369-3 connectors many years ago, most patients continue to use legacy tubes with a significant lack of knowledge about ISO-80369-3 connectors. The survey results guide HEN providers to focus on several areas to reduce complications.
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Affiliation(s)
- Osman Mohamed Elfadil
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Ankitaben Patel
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Francisca Joly
- Department of Gastroenterology and Nutritional Support, Center for Intestinal Failure, Reference Centre of Rare Disease MarDI, AP-HP Beaujon Hospital, University of Paris Inserm UMR 1149, Paris, France
| | - Simon Lal
- Gastroenterology, Salford Royal & University of Manchester, UK
| | | | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Palle B Jeppesen
- Department of Intestinal Failure and Liver Diseases, Rigshospitalet, Inge Lehmanns Vej 5 Opgang 3, 12. Og 16. Sal 2100 København Ø, Denmark
| | - Andre Van Gossum
- Department of Gastroenterology and Clinical Nutrition, Hospital Erasme/Institut Bordet (HUB) Brussels, Belgium
| | - Geert Wanten
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Georg Lamprecht
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University, Medical Center, Rostock, Germany
| | - Tim Vanuytsel
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospital Leuven, Leuven, Belgium
| | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Ryan T Hurt
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
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3
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Murray G, Ramsey ML, Hart PA, Roberts KM. Fat malabsorption in pancreatic cancer: Pathophysiology and management. Nutr Clin Pract 2024; 39 Suppl 1:S46-S56. [PMID: 38429964 DOI: 10.1002/ncp.11129] [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: 09/08/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 03/03/2024] Open
Abstract
Exocrine pancreatic insufficiency (EPI) is common in pancreatic ductal adenocarcinoma (PDAC) and may lead to significant nutrition compromise. In the setting of cancer cachexia and gastrointestinal toxicities of cancer treatments, untreated (or undertreated) EPI exacerbates weight loss, sarcopenia, micronutrient deficiencies, and malnutrition. Together, these complications contribute to poor tolerance of oncologic therapies and negatively impact survival. Treatment of EPI in PDAC involves the addition of pancreatic enzyme replacement therapy, with titration to improve gastrointestinal symptoms. Medical nutrition therapies may also be applicable and may include fat-soluble vitamin replacement, medium-chain triglycerides, and, in some cases, enteral nutrition. Optimizing nutrition status is an important adjunct treatment approach to improve quality of life and may also improve overall survival.
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Affiliation(s)
- Gretchen Murray
- Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Nutrition Services, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mitchell L Ramsey
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kristen M Roberts
- Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Madrid-Paredes A, Leyva-Martínez S, Ávila-Rubio V, Molina-Soria JB, Sorribes-Carrera P, Yeste-Doblas C, López-Medina JA, Luna-López VE, Fernández-Soto ML. Impact of nutritional and educational support on home enteral nutrition. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:45. [PMID: 37218015 DOI: 10.1186/s41043-023-00384-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 05/10/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Home Enteral Nutrition (HEN) is used to prevent or correct malnutrition in outpatients. Due to the complexity of this process, the indication, follow-up, and results of an educational program of HEN patients was evaluated. METHODS A prospective, observational, real-life, multicenter study was performed in 21 Spanish Hospital. Patients receiving HEN by nasogastric tube or ostomy were included. The following variables were collected: age, gender, HEN indication, type of formula, nutritional requirements, laboratory variables, complications, and quality standards of the educational program. To calculate the energy and protein requirements, the FAO/WHO/UNU formula was used considering the adjusted weight of the patients. All data were analyzed using SPSS.24. RESULTS 414 patients were included. Most conditions diagnosed were neurodegenerative diseases (64.8%). 100 (25.3%) were diabetic. The mean weight was 59.3 ± 10.4 kg and BMI 22.6 ± 3.2. Moderate protein-calorie malnutrition was predominant at baseline (46.4%). Improvement in nutritional status at six months was recorded in more than 75% of patients (p < 0.05). Tolerance problems, diarrhea and abdominal distension fell between the 3- and 6-month visits (p < 0.05). Patients who received intermittent EN had fewer tolerance-related effects (OR 0.042; 95% CI 0.006-0.279) and less diarrhoea (OR 0.042; 95% CI 0.006-0.279). At the baseline and 6-month visits, compliance with the educational measures proposed by the prescriber was ≥ 99%. CONCLUSION The nutritional assessment to prescribe individualized HEN to each patient, together with educational measures and training in the proper use of this treatment for both patients and trainers, improves nutritional status and reduces the onset of adverse events.
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Affiliation(s)
- Adela Madrid-Paredes
- Servicio Farmacia Hospitalaria, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada, Av. del Conocimiento, s/n, 18016, Granada, Spain.
| | - Socorro Leyva-Martínez
- Unidad de Nutrición Clínica y Dietética, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada, Av. del Conocimiento, s/n, 18016, Granada, Spain
| | - Verónica Ávila-Rubio
- Unidad de Nutrición Clínica y Dietética, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada, Av. del Conocimiento, s/n, 18016, Granada, Spain
| | - Juan Bautista Molina-Soria
- Unidad de Nutrición Clínica y Dietética, Hospital Universitario San Agustín, AGS Norte de Jaén en Linares (Jaén), Av. San Cristóbal, 2D, 23700, Linares, Jaén, Spain
| | - Patricia Sorribes-Carrera
- Unidad de Nutrición Clínica y Dietética, Consorcio Hospitalario Provincial de Castellón, Avda. Dr. Clará 19 (704,29 km), 12002, Castellón de La Plana, Spain
| | - Carmen Yeste-Doblas
- Unidad de Nutrición Clínica y Dietética, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada, Av. del Conocimiento, s/n, 18016, Granada, Spain
| | - José Antonio López-Medina
- Unidad de Nutrición Clínica y Dietética, Hospital Universitario Virgen de la Victoria, Campus de Teatinos, s/n, 29010, Málaga, Spain
| | - Victoria Eugenia Luna-López
- Unidad de Nutrición Clínica y Dietética, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014, Granada, Spain
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Lord LM, McGinnis C, Densmore C. Addressing the unique needs and quality of life issues for adults receiving long-term home enteral nutrition. Nutr Clin Pract 2023; 38:257-276. [PMID: 36917006 DOI: 10.1002/ncp.10965] [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: 12/06/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 03/16/2023] Open
Abstract
Individuals who require home enteral nutrition (EN)-and, subsequently, their families-undergo major changes in family dynamics. They would benefit from an approach that provides ongoing nutrition, hydration, enteral access, and quality of life assessments from knowledgeable clinicians. Most individuals and families will be new to the enteral access device, handling and administration of the nutrition formula, medication delivery through feeding tubes, and troubleshooting associated complications. Educational sessions are typically given but may not be comprehensive enough to meet all needs, especially in the first weeks to months of home EN therapy. Quality of life assessments obtained in the early stages of EN support would help clinicians identify and focus on areas that need special attention for that individual and family. Ongoing clinical care is essential because over time, the nutrition prescription, delivery methods and schedules typically require alterations and feeding tubes need to be assessed and replaced. In addition to these important physical dimensions of care, attention should be placed on the psychological, cognitive, social, and ethical aspects of life for these individuals and their families.
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Affiliation(s)
- Linda M Lord
- Adult Nutrition Support Clinic, University of Rochester Medical Center, Rochester, NY, USA
| | - Carol McGinnis
- Sanford USD Medical Center, Center for Care Management, Sioux Falls, SD, USA
| | - Carly Densmore
- Adult Nutrition Support Clinic, University of Rochester Medical Center, Rochester, NY, USA
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A scoping review of best practices in home enteral tube feeding. Prim Health Care Res Dev 2022; 23:e43. [PMID: 35924718 PMCID: PMC9381166 DOI: 10.1017/s1463423622000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Milton D, Murphy B, Johnson TW, Carter H, Spurlock AY, Hussey J, Johnson K. Low risk for microbial contamination of syringe and tube feeding bag surfaces after multiple reuses with home blenderized tube feeding. Nutr Clin Pract 2022; 37:907-912. [PMID: 35233842 DOI: 10.1002/ncp.10835] [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: 11/11/2022] Open
Abstract
BACKGROUND Guidelines for the reuse of enteral tube feeding (ETF) equipment guidelines are limited to manufacturer recommendations. ETF equipment reuse studies are needed as the enteral population has increased, along with blenderized tube feeding (BTF). METHODS This experiment tested microbial contamination of a reusable gravity feeding bag and syringe after 15 BTF reuses and cleanings. Eight bags and syringes were filled with the BTF, held at room temperature for 20 min, and then emptied, washed, and air dried. After the last air drying, the inner surfaces of the bag and syringe were swabbed, and aerobic microbial counts were performed using serial dilutions and plate counts. RESULTS The microbial counts for all syringes and six bags were <1 colony-forming unit (CFU)/cm2 ; one bag was <5 CFU/cm2 and one bag was 12.5 CFU/cm2 . No legal guidelines for surface cleanliness exist for the food sector. Several studies propose a safe microbial level to be <2.5 CFU/cm2 , and the European Commission recommended <10 CFU/cm2 . Based on these proposed guidelines, microbial counts of all syringes and seven bags were within the proposed guidelines, except for one bag just above 10 CFU/cm2 . CONCLUSION The feeding bag used in this study may be used multiple times for BTF with a reduced risk of microbial contamination when manufacturer's cleaning guidelines are followed. Although bolus tube feeding is an off-label use for syringes, they are frequently used for BTF, and in this study the cleaning after 15 uses over 5 days was effective to reduce microbial counts.
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Affiliation(s)
- Debra Milton
- Department of Molecular Biology, Umeå University, Umeå, Sweden
| | - Brie Murphy
- Biological Sciences, Troy University, Troy, Alabama, USA
| | - Teresa W Johnson
- Department of Kinesiology and Health Promotion, Troy University, Troy, Alabama, USA
| | - Holly Carter
- School of Nursing, Troy University, Troy, Alabama, USA
| | | | - Jenna Hussey
- School of Nursing, Troy University, Troy, Alabama, USA
| | - Kelly Johnson
- School of Nursing, Troy University, Troy, Alabama, USA
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8
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Mou J, Sun J, Zhang R, Yang Y, Yang W, Zhao X. Experiences and needs of home caregivers for enteral nutrition: A systematic review of qualitative research. Nurs Open 2022; 9:11-21. [PMID: 34273248 PMCID: PMC8685892 DOI: 10.1002/nop2.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 11/11/2022] Open
Abstract
AIMS To systematically identify, evaluate and synthesize the qualitative evidence on enteral nutrition of home caregivers. DESIGN A qualitative evidence synthesis using the Sandelowski and Barroso methodology. DATA SOURCES We reviewed articles from eight databases: CINAHL, Embase, PubMed, Web of Science, Cochrane, CNKI, Wanfang Data and CSTJ. Qualitative, peer-reviewed, original studies published in English or Chinese before April 2020 on home caregivers' experience and needs for enteral nutrition were included. The studies were selected by screening titles, abstracts and full texts, and the quality of each study was assessed by two researchers independently. REVIEW METHODS Two researchers independently used qualitative assessment and review tools for quality assessment and thematic synthesis for data analysis. RESULTS This review included 10 articles. The themes identified included balance the enteral nutrition, the experiences and feelings in practice and the recommendations to meet challenge. CONCLUSION Home caregivers reported that they played an important role and faced greater pressure. Future studies should establish a systematic and standardized follow-up schedule to improve home caregivers' physical and mental health. IMPACT The findings established that home caregivers experienced not only changes in their roles and concerns but also spiritual changes. Home caregivers develop different coping strategies to adapt to enteral nutrition without standardized training and support. Although home caregivers make much account of enteral nutrition and feeding issues, they lack of information and support services. Understanding existing problems from a caregiver's perspective can allow interventions to be more clearly developed and well-established training standards established in the future.
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Affiliation(s)
- Jingjing Mou
- The First Hospital of Jilin UniversityChangchunJilin ProvinceChina
| | - Jianan Sun
- The First Hospital of Jilin UniversityChangchunJilin ProvinceChina
| | - Rui Zhang
- The First Hospital of Jilin UniversityChangchunJilin ProvinceChina
| | - Yang Yang
- The First Hospital of Jilin UniversityChangchunJilin ProvinceChina
| | - Wenwen Yang
- The First Hospital of Jilin UniversityChangchunJilin ProvinceChina
| | - Xiaosu Zhao
- The First Hospital of Jilin UniversityChangchunJilin ProvinceChina
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Alsunaid S, Holden VK, Kohli A, Diaz J, O'Meara LB. Wound care management: tracheostomy and gastrostomy. J Thorac Dis 2021; 13:5297-5313. [PMID: 34527367 PMCID: PMC8411156 DOI: 10.21037/jtd-2019-ipicu-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/27/2020] [Indexed: 01/12/2023]
Abstract
Percutaneous dilatational tracheostomy (PDT) and percutaneous endoscopic gastrostomy (PEG) tube placements are routine procedures performed in the intensive care units (ICUs). They are performed to facilitate care and promote healing. They also help prevent complications from prolonged endotracheal intubation and malnutrition. In most cases, both are performed simultaneously. Physicians performing them require knowledge of local anatomy, tissue and vascular relationships, along with advance bronchoscopy and endoscopy skills. Although PDTs and PEGs are considered relatively low-risk procedures, operators need to have the knowledge and skill to recognize and prevent adverse outcomes. Current published literature on post-procedural care and stoma wound management was reviewed. Available recommendations for the routine care of tracheostomy and PEG tubes are included in this review. Signs and symptoms of early PDT- and PEG-related complications and their management are discussed in detail. These include hemorrhage, infection, accidental decannulation, tube obstruction, clogging, and dislodgement. Rare, life-threatening complications are also discussed. Multidisciplinary teams are needed for improved patient care, and members should be aware of all pertinent care aspects and potential complications related to PDT and PEG placement. Each institute is strongly encouraged to have detailed protocols to standardize care. This review provides a state-of-the-art guidance on the care of patients with tracheostomies and gastrostomies specifically in the ICU setting.
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Affiliation(s)
- Sammar Alsunaid
- Division of Pulmonary & Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Van K Holden
- Division of Pulmonary & Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Akshay Kohli
- Department of Internal Medicine, Medstar Washington Hospital Center, Georgetown University, Washington, DC, USA
| | - Jose Diaz
- Division of Acute Care Emergency Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Lindsay B O'Meara
- Division of Acute Care Emergency Surgery, University of Maryland Medical Center, Baltimore, MD, USA
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Eustace K, Cole L, Hollaway L. Attitudes and Perceptions of Blenderized Tube Feed Use Among Physicians and Advanced Practice Providers. JPEN J Parenter Enteral Nutr 2021; 45:1755-1761. [PMID: 33433025 DOI: 10.1002/jpen.2069] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Blenderized tube feeds (BTFs) have increased in popularity among enteral patients and their caregivers as an alternative to commercial formula. Motivations include ingredient flexibility, increased tolerance, and inclusion in family meals. Research has explored the attitudes and perceptions of patients, caregivers, and registered dietitian nutritionists but not those of physicians and advanced practice providers (APPs). The purpose of this study was to evaluate their attitudes and perceptions of BTFs. METHODS A survey created via Research Electronic Data Capture tools was distributed to physicians and APPs to evaluate clinical practice characteristics, experience, knowledge, and perceptions of BTFs. RESULTS Survey response rate was 17.3% (n = 206). Half of respondents reported familiarity with BTFs, but 95% of respondents had received no formal training regarding BTFs. Physicians reported higher levels of confidence in BTF knowledge than APPs. However, the overall level of confidence in BTF knowledge was poor, with a majority of respondents (73.3% [n = 151]) reporting either "not very confident" or "not confident at all." The most perceived benefits included tailoring diet to better fit the patients' needs (70.9% [146]) and psychological benefits (59.2% [122]). Barriers that most concerned respondents included tube occlusions (59.7% [123]) and nutrition inadequacy (47.6% [98]). χ2 Analysis revealed no relationship between type of provider and perceived benefits or barriers. CONCLUSION A majority of physicians and APPs are willing to support BTF use but lack education or guidance, resulting in poor confidence. Increased familiarity with BTF use and awareness of available education materials are required to help physicians and APPs support patients utilizing BTFs.
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Affiliation(s)
- Kathleen Eustace
- Department of Clinical Nutrition, School of Health Professions, University of Texas Southwestern, Dallas, Texas, USA
| | - Lillian Cole
- Paragon Home Infusion, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lauren Hollaway
- Children's Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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11
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D’Onofrio V, Del Chierico F, Belci P, Vernocchi P, Quagliariello A, Reddel S, Conta G, Mancino MV, Fadda M, Scigliano MC, Morelli R, De Francesco A, Guagnini F, Fassio F, Galletti R, Putignani L. Effects of a Synbiotic Formula on Functional Bowel Disorders and Gut Microbiota Profile during Long-Term Home Enteral Nutrition (LTHEN): A Pilot Study. Nutrients 2020; 13:nu13010087. [PMID: 33383954 PMCID: PMC7824736 DOI: 10.3390/nu13010087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/17/2020] [Accepted: 12/24/2020] [Indexed: 02/07/2023] Open
Abstract
Long-term enteral nutrition (LTEN) can induce gut microbiota (GM) dysbiosis and gastrointestinal related symptoms, such as constipation or diarrhoea. To date, the treatment of constipation is based on the use of laxatives and prebiotics. Only recently have probiotics and synbiotics been considered, the latter modulating the GM and regulating intestinal functions. This randomized open-label intervention study evaluated the effects of synbiotic treatment on the GM profile, its functional activity and on intestinal functions in long-term home EN (LTHEN) patients. Twenty LTHEN patients were recruited to take enteral formula plus one sachet/day of synbiotic (intervention group, IG) or enteral formula (control group, CG) for four months and evaluated for constipation, stool consistency, and GM and metabolite profiles. In IG patients, statistically significant reduction of constipation and increase of stool consistency were observed after four months (T1), compared to CG subjects. GM ecology analyses revealed a decrease in the microbial diversity of both IC and CG groups. Biodiversity increased at T1 for 5/11 IG patients and Methanobrevibacter was identified as the biomarker correlated to the richness increase. Moreover, the increase of short chain fatty acids and the reduction of harmful molecules have been correlated to synbiotic administration. Synbiotics improve constipation symptoms and influences Methanobrevibacter growth in LTHEN patients.
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Affiliation(s)
- Valentina D’Onofrio
- S.C. Dietetica e Nutrizione Clinica, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (V.D.); (P.B.); (M.V.M.); (M.F.); (M.C.S.); (R.M.); (A.D.F.); (R.G.)
| | - Federica Del Chierico
- Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.D.C.); (P.V.); (A.Q.); (S.R.)
| | - Paola Belci
- S.C. Dietetica e Nutrizione Clinica, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (V.D.); (P.B.); (M.V.M.); (M.F.); (M.C.S.); (R.M.); (A.D.F.); (R.G.)
| | - Pamela Vernocchi
- Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.D.C.); (P.V.); (A.Q.); (S.R.)
| | - Andrea Quagliariello
- Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.D.C.); (P.V.); (A.Q.); (S.R.)
| | - Sofia Reddel
- Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.D.C.); (P.V.); (A.Q.); (S.R.)
| | - Giorgia Conta
- Department of Chemistry, Sapienza University of Rome, 00185 Rome, Italy;
- NMR-Based Metabolomics Laboratory, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Vittoria Mancino
- S.C. Dietetica e Nutrizione Clinica, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (V.D.); (P.B.); (M.V.M.); (M.F.); (M.C.S.); (R.M.); (A.D.F.); (R.G.)
| | - Maurizio Fadda
- S.C. Dietetica e Nutrizione Clinica, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (V.D.); (P.B.); (M.V.M.); (M.F.); (M.C.S.); (R.M.); (A.D.F.); (R.G.)
| | - Maria Carmine Scigliano
- S.C. Dietetica e Nutrizione Clinica, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (V.D.); (P.B.); (M.V.M.); (M.F.); (M.C.S.); (R.M.); (A.D.F.); (R.G.)
| | - Roberta Morelli
- S.C. Dietetica e Nutrizione Clinica, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (V.D.); (P.B.); (M.V.M.); (M.F.); (M.C.S.); (R.M.); (A.D.F.); (R.G.)
| | - Antonella De Francesco
- S.C. Dietetica e Nutrizione Clinica, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (V.D.); (P.B.); (M.V.M.); (M.F.); (M.C.S.); (R.M.); (A.D.F.); (R.G.)
| | - Fabio Guagnini
- Allergy Therapeutics Italia, Milan, Italy e GE Healthcare, 20019 Milan, Italy;
| | - Filippo Fassio
- Allergy and Clinical Immunology Unit, San Giovanni di Dio Hospital, Azienda USL Toscana Centro, 50143 Florence, Italy;
| | - Rosalba Galletti
- S.C. Dietetica e Nutrizione Clinica, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (V.D.); (P.B.); (M.V.M.); (M.F.); (M.C.S.); (R.M.); (A.D.F.); (R.G.)
| | - Lorenza Putignani
- Department of Diagnostic and Laboratory Medicine, Unit of Parasitology and Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00147 Rome, Italy
- Correspondence: ; Tel.: +39-68594127-2598
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12
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Velapati SR, Schroeder SE, Schroeder DR, Buttar NS, Mohamed Elfadil O, Hurt RT, Mundi MS. Use of Home Enteral Nutrition in Malnourished Post-Bariatric Surgery Patients. JPEN J Parenter Enteral Nutr 2020; 45:1023-1031. [PMID: 32997355 DOI: 10.1002/jpen.1973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/14/2020] [Accepted: 07/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Bariatric surgery is by far the most effective treatment option available for successfully achieving and maintaining weight loss in the obese population, but it can also be associated with complications that lead to malnutrition. There is limited data on how enteral nutrition (EN) can be used to provide nutrition support in such cases. METHODS Retrospective review of our Home Enteral Nutrition (HEN) database was conducted from February 2013 to April 2018 to identify patients who received HEN because of bariatric surgery-related complication. RESULTS During the study period, 72 patients (86% female, mean age 50.3 ± 11.6 years) initiated HEN because of bariatric surgical complication. Most common bariatric surgery was Roux-en-Y (74%) and most common indication for HEN was malnutrition/failure to thrive (33%). HEN was most commonly provided through nasojejunal feeds and resulted in an average increase in body weight and body mass index from 74.8 kg and 26.5, respectively, before HEN to 76.9 kg and 27.2, respectively, at the end of the HEN period. Through HEN, patients received 22.2 ± 7.9 kcal/kg/d and 1.0 ± 0.3 g/kg/d protein, meeting 94% ± 17% of their energy goals and 95% ± 29% of their protein goals. Vitamin deficiencies were noted in 69% of patients at the time of HEN initiation, which improved to 10% after enteral feeds and appropriate vitamin supplementation. CONCLUSION HEN is safe and effective in treating malnutrition and vitamin deficiencies that might occur as a complication of bariatric surgery, leading to avoidance of parenteral nutrition support in most cases.
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Affiliation(s)
- Saketh R Velapati
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Navtej S Buttar
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA
| | - Osman Mohamed Elfadil
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan T Hurt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
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13
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Milton DL, Johnson TW, Johnson K, Murphy B, Carter H, Hurt RT, Mundi MS, Epp L, Spurlock AY, Hussey J. Accepted Safe Food‐Handling Procedures Minimizes Microbial Contamination of Home‐Prepared Blenderized Tube‐Feeding. Nutr Clin Pract 2020; 35:479-486. [DOI: 10.1002/ncp.10450] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Debra L. Milton
- Department of Biological and Environmental Sciences Troy University Troy Alabama USA
| | | | | | - Brie Murphy
- Department of Biological and Environmental Sciences Troy University Troy Alabama USA
| | - Holly Carter
- School of Nursing, Troy University Troy Alabama USA
| | | | | | - Lisa Epp
- Mayo Clinic Rochester Alabama USA
| | | | - Jenna Hussey
- School of Nursing, Troy University Troy Alabama USA
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14
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Tanaka Y, Tateishi R, Koike K. Successful treatment of chronic hepatitis C virus infection with crushed glecaprevir/pibrentasvir administered via a percutaneous endoscopic gastrostomy tube: case report and review of the literature. Clin J Gastroenterol 2019; 12:588-591. [PMID: 31134448 DOI: 10.1007/s12328-019-00997-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/16/2019] [Indexed: 02/07/2023]
Abstract
Glecaprevir (GLE)/pibrentasvir (PIB) is a direct-acting antiviral regimen approved for patients infected with hepatitis C virus. No data are available on the safety and efficacy of this regimen when crushed and administered through a percutaneous endoscopic gastrostomy (PEG) tube. Here, we report a patient who successfully achieved a sustained viral response after treatment with GLE/PIB administered via a PEG tube. A 41-year-old female with chronic hepatitis C viral infection was referred to our department for treatment. She had a history of spina bifida and hydrocephalus, and she received a PEG tube for nutrition and medication due to an aftereffect of hydrocephalus. She received crushed GLE/PIB treatment through a PEG tube for 8 weeks and achieved a sustained viral response 12, without any treatment-related severe adverse events. This is the first documented case treated with GLE/PIB administered through a PEG tube. Based on this case report and a review of the literature, we discuss the safety and efficacy of direct-acting antiviral treatment via a PEG tube.
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Affiliation(s)
- Yasuo Tanaka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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