Stir, Shake or Blend: A Comparison of Methods Used to Reduce Viscosity of Blenderized Tube Feedings

Abstract

Blenderized tube feeding (BTF) refers to formula composed of whole foods and purees, blended to a consistency that can be administered through an enteral feeding device. BTFs have a higher viscosity than conventional enteral formulas and may be mixed with extra liquid to aid in administration via an enteral feeding device. This study compared changes in viscosity of commercially available BTF s when stirred, shaken, or blenderized. The International Dysphagia Diet Standardisation Initiative flow test was used to provide an objective level of viscosity. Our results indicate that the method chosen to thin BTFs results in significant differences in viscosity and varies depending on the percent of water by volume added to the formula as well as the presence of additional non-food ingredients such as synthetic supplements. We conclude that the method used to thin BTFs should be taken into account when a consistent viscosity level is desired.

Pediatric formulas: Categories, composition, and considerations

“…Some products have as many as 780 mOsm/kg, which correlates with their high‐calorie density, many of which are as high as 1.3 kcal/ml. While caregivers generally administer BTF formulas via bolus feeds via gravity bags or syringe, some can be administered via pump, though they may require thinning with water prior to administration to prevent clogging due to their increased viscosity 29,30 . Packaging is an often‐overlooked consideration in the discussion of enteral formula selection.…”

“…Method of delivery, namely pump, gravity, and tube diameter, also impacts formula selection based on viscosity. Thicker, blended formulas cannot pass through small caliber nasogastric tube or jejunostomy tubes and may need to be diluted, resulting in larger volumes to administer 29 . Conversely, patients with gastroesophageal reflux often tolerate higher‐viscosity formulas better 30 …”

“…While caregivers generally administer BTF formulas via bolus feeds via gravity bags or syringe, some can be administered via pump, though they may require thinning with water prior to administration to prevent clogging due to their increased viscosity. 29,30 Packaging is an often-overlooked consideration in the discussion of enteral formula selection. Many BTF products are sold in non-resealable pouches, making the use of any volume other than the exact amount contained in a pouch relatively more inconvenient for caregivers.…”

“…Commercial and homemade BTF formulas generally lack palatability, if undiluted require 12 or 14 Fr or large‐diameter enteral access devices, and are viscous 25,29–31 . Commercially available BTF formula ranges from a mixture of blended foods and formulas to products which are entirely food‐based.…”

“…28 Commercial and homemade BTF formulas generally lack palatability, if undiluted require 12 or 14 Fr or largediameter enteral access devices, and are viscous. 25,[29][30][31] Commercially available BTF formula ranges from a mixture of blended foods and formulas to products which are entirely food-based. BTF formulas are distinct from standard or hydrolyzed formulas that are made entirely from plants, as the latter are not produced in a blenderized manner.…”