Cross‐sectional Evaluation of Home Enteral Nutrition Practice in the United States in the Context of the New Enteral Connectors

Abstract

Purpose: The increased prevalence of home enteral nutrition (HEN), reemergence of blenderized tube feeding (BTF), and conversion of enteral connectors to the ISO 80369-3 standard are creating a significant need to better understand the practices of the HEN population. A cross-sectional survey of current HEN consumers was conducted to evaluate the demographics of HEN consumers, including formulas and feeding tubes being used. Methods: In order to disseminate the survey to a wide range of HEN consumers, we partnered with private infusion companies (Coram and Pediatric Home Services) along with the Oley and Tube Feeding Awareness Foundations. A validated survey focusing on patient demographics, tube types, formula used, and tube clogging complications was placed online from September 1, 2016, to October 15, 2016. Results: During the study period, 1519 surveys were completed, with 1062 respondents in the pediatric group (<18 years old) and 457 in the adult group (ࣙ18 years old). The most popular formulas were standard polymeric and specialized formulas in both the pediatric and adult groups. However, a significant number in the pediatric (31.2%) and adult (18.6%) groups used BTF either alone or in combination with other formulas. Clogging was also quite prevalent and correlated with tube size. Conclusions: The present study highlights the significant diversity of the HEN practice in terms of types and sizes of tubes as well as formulas used, including confirmation of the widespread use of BTF. These data are key to ensure HEN providers are able to appropriately support and educate their patients. (JPEN J Parenter

Reduction in Healthcare Utilization With Transition to Peptide‐Based Diets in Intolerant Home Enteral Nutrition Patients

“…In addition to transitioning SPF‐intolerant HEN patients to PBDs, another trend that is emerging is the use of blenderized tube feeding (BTF). Cross‐sectional evaluation has yielded varying results depending on the cohort evaluated, with 18%–68% of adults and 30%–89% of pediatric HEN patients using BTF in some capacity 32‐34 . Multiple reasons for using BTF have been reported, including BTF being more natural and patient desire to consume what the family is consuming, as well as tolerating BTF better 32 .…”

“…Cross-sectional evaluation has yielded varying results depending on the cohort evaluated, with 18%-68% of adults and 30%-89% of pediatric HEN patients using BTF in some capacity. [32][33][34] Multiple reasons for using BTF have been reported, including BTF being more natural and patient desire to consume what the family is consuming, as well as tolerating BTF better. 32 Despite widespread reported use in cross-sectional studies, there are limited data from clinical trials, especially randomized controlled trials.…”

Synthesis of research on ENFit gastrostomy tubes with potential implications for US patients using these devices

“…To estimate the fraction of the population affected by the transition from legacy to ENFit‐based G‐tube devices, we performed an analysis for this article using the FDA's previously published experimental results 12 , 22 and a patient practices survey 9 conducted by the Mayo Clinic. As a first step, a threshold characterizing a clinically relevant difference was established.…”

“…Figure 2 shows the timeline of the introduction of the ISO standard along with salient events and research in the last decade pertaining to the ISO standard. To reduce enteral misconnections, it is expected that nearly 500,000 feeding tube users in the US will be transitioning to the new feeding tubes with the ISO 80369‐3 connectors 9,10 . Although the ISO 80369‐3 standard stipulates an enteral small‐bore connector (internal) diameter of 2.9 mm, the standard does not specify all dimensions of a finished gastrostomy tube (G‐tube) device (eg, the length of the connector outside the physical connection) nor the direction of male‐female connections.…”

Criterios GLIM: análisis de su consistencia interna y una comparación con respecto a la valoración global subjetiva

“…No existe un acuerdo sobre la herramienta de tamizaje a utilizar. Dentro de las herramientas validadas se encuentra el Short Nutritional Assessment Questionnaire (SNAQ), el cual es empleado en nuestro centro por su practicidad (3)(4)(5) .…”