1.09/ Blenderized Tube Feeding - Providing Options for Patients

INTRO: Welcome to Clinical Nutrition Notes, a podcast where we speak with guest experts and opinion leaders about the art and science of clinical nutrition. Brought to you by Nestlé Health Science Canada. This podcast is intended for healthcare professionals for educational purposes.

I’m your host Cindy Steel, medical affairs manager with Nestlé Health Science.

Today we’ll be speaking with Claire Kariya, to get an understanding of the growing interest and some might say a shift in practice, to incorporate more food-based solutions in the nutritional management of individuals requiring nutrition support.

Claire Kariya is a registered dietitian and a certified nutrition support clinician who has been working since 2005 at the Vancouver General Hospital. Claire focuses on the care of tube fed adult patients and has a special interest in the use of blended food for tube feeding both in the acute care setting and at home. Claire has published and presented on this topic and has developed blenderized tube feeding resources for her health authority to support patients and families.

Steel: Thank you for joining us Claire. To set the stage, can you briefly describe the clinical setting where you work?

Kariya: Yes, I work with acutely ill and critically ill patients at Vancouver General Hospital, and I have a private practice where I focus on the care of home tube fed clients with an interest in blenderized tube feeding.

Steel: Ok, thanks for that. To get us started, when you say blenderized tube feeding or food-based tube feeding, can you briefly explain what are we really talking about?

Kariya: Blenderized tube feeding is usually defined as food and fluid that has been blended, as needed, for consumption through a feeding tube and that could include food in any amount. It could involve taking some fresh food and mixing it in with a standard commercial product or it could include commercial food-based product, or it could entail a diet that’s made up of 100% of homemade blended food.

Steel:As a clinician, tell us what you’re witnessing or experiencing with respect to patients and caregivers and their attitudes towards these food-based or blenderized tube feedings.

Kariya:I’ve definitely noticed a growing interest in the use of blenderized tube feeding where the patients are more interested in the natural options. They’re definitely wanting whole food choices, and they’re looking at ingredient panels, whereas 5 years ago, I would never have patients say, “I’ve looked at the ingredients and I want something different”, when they’re looking at commercial products. Yes, I’d definitely say there’s a trend towards more natural choices, more appealing ingredient panels, and definitely more care about what goes into their diets.

Steel:Would you say it’s the same or different when it comes to the attitudes or beliefs of dietitians and other healthcare professionals? I guess this is what your research was focused on, wasn’t it?

Kariya: Exactly. I was interested in seeing what do dietitians feel when it comes to the use of homemade blended food for tube feeding. My studies showed that dietitians are very supportive of the use of blended food for tube feeding, but there is some hesitation because generally most dietitians haven’t had education on the topic or really any experience. I do feel that clinicians are open to blenderized tube feeding as an option for tube fed patients, it’s just a matter of having the resources, time and experience to be able to best support those patients who make the choice for blended food.

Steel: For a while we were not condoning or not recommending the practice, but it’s nice to see a shift. Do you proactively suggest food-based tube feeding options, or do you typically wait until patients, families or caregivers ask you about it?

Kariya: When I’m aware of a patient needing long-term tube feeding or home tube feeding I always bring up the choice of blenderized tube feeding. What I present my patients with is 3 choices: they can use standard commercial products, commercial food-based products, or they can make their own homemade blended food for tube feeding, or they can use any combination of those 3 choices.

Steel: Clinically speaking, are there times when homemade blenderized tube feedings wouldn’t be appropriate for a patient?

Kariya: There could be situations where homemade blenderized tube feeding is inappropriate, those would generally be situations where a patient is acutely or critically ill, or perhaps their medical condition necessitates a very concentrated tube feeding formula, like a 2 calorie/ml product for example. You really can’t mimic that calorie density with homemade blended food. Generally, in the home setting, you can usually go with blenderized tube feeding because a patient at home would likely be much more well, and stable, and would probably be a good candidate, but every situation needs to be looked at individually.

Steel:That makes sense. I’d like to talk about those individuals that are appropriate for homemade blenderized tube feeding. Do they usually adapt an all-or-none approach, or do you find patients and caregivers are open to using blenderized tube feeding when it works and other options when it doesn’t?

Kariya: I find that mostly they’re open to using other options for times where it’s more convenient to do so, or when they’re tired, travelling, or there could be many situations where if they’re reliant 100% on homemade blended food, it just wouldn’t be practical. In my experience, most patients make the choice to do homemade blended food when it works for them, but they should always have some sort of backup plan of having a commercial product on hand for those times where it’s going to come in handy.

Steel: I once heard another dietitian with experience in home blenderized feeding say that for so many years, she swayed patients and families away from that decision. But when she learned more, she started to listen to her patients and started to respect their requests a bit more; she found that it was reciprocated with the patients, and they started to listen more and respect what she was saying, and be more open to her suggestions and guidance. Have you experienced a similar mindset in your patients when you made that shift to start promoting the practice?

Kariya: Yes, I think I have noticed exactly what you’re saying that dietitian described. Once my patients know that I’m open to the option of blenderized or homemade blended food, they seem to be more open as far as sharing what they actually have been doing in a home setting. Whereas I think if they get the impression that you’re opposed to blenderized tube feeding they might just tell you that they’re using a standard commercial product and not actually give you the truth, which is that they’re not actually using those products and they’re making their own blended food. I think it’s so important that you approach patients with the right attitude and with an acceptance of what their choice is, if they have chosen to use blenderized tube feeding. If they know that you’re on their side as far as that decision, then if you feel they would benefit from incorporating some commercial product into their diet, or maybe they’re admitted to hospital and you feel that a commercial product would better support them in hospital (if they know that you are supportive in general of blenderized tube feeding), I have found that they are much more receptive to whatever my recommendation may be; even if it means a change back to commercial product.

Steel: Again, that make sense. People are going to do what they’re going to do, aren’t they. But that makes sense that once you’re respectful of them, they’re going to be more respectful of your choices as well. Where would you tell a clinician, who’s new or just wanting to get started on recommending blenderized tube feeding, to go to for resources?

Kariya: I think the best article that was recently written for clinicians was written by Lisa Epp, a dietitian in the US. It’s in Nutrition Issues and Practical Gastroenterology. It goes through a great review of all the evidence which I think is important for clinicians that aren’t as familiar with blenderized tube feeding. It lists supplies that would be needed for a patient who chooses to use homemade blended food for tube feeding. It also gives some sample recipes for different calorie levels. I’d definitely recommend that particular article. I also have a lot of resources at naturaltubefeeding.com, which is the website for my private practice. There’s patient handouts, tested recipes, and the blog with lots of information, that could be another source. I also really like Nestlé’s website about Compleat®, where there’s recipes for taking the original Compleat® product and adding in foods to bring it up to a more blenderized homemade type of product. I feel like those recipes could be used with other commercials products as well.

Steel: Thank you. As we wrap up, or getting close to wrapping up, any other advice you have for dietitians or other healthcare professionals interested in helping their patients that are wanting to blenderize their own tube feeds?

Kariya: My advice is to do your best to support your patients in that choice of choosing homemade blended food for tube feeding, or blenderized tube feeding. You do have the skills and ability to help support them. All the research has shown that generally blenderized tube feeding is safe and effective for preventing malnutrition with appropriate nutrition. The studies where a dietitian has been involved in the care of a patient as part of the study protocol, the patients have always done well. I think that’s really important to note, that if a dietitian is involved the risk of nutritional inadequacy or food safety problems, they’re dramatically reduced. My advice would be to support your patients, learn as you go if you have to. You can learn a lot from your patients. If you are supportive you will be rewarded. It’s a great clinical additional to our practice.

Steel: It’s kind of exciting times, isn’t it, that this practice is taking off. So finally, so our listeners get to know you a little more. A question that we’ve asked all of our podcast guests is: can you tell us how you first became interested in the field of nutrition?

Kariya:I was an athlete in track and field, and I was initially interested in nutrition as far as how it could help my performance so I began studying it in university. The more I studied it, the more I was fascinated by the science, then I realized that I really wanted a career in nutrition. Eventually through experiencing clinical nutrition in my internship I knew that a clinical setting, tube feeding and parenteral nutrition what was I really loved, and luckily for me I’ve made a career out of that.

Steel: And we’re glad you did. And on that note, I’d like to thank Claire Kariya for joining us and for shedding some light on the growing interest and practice shift towards including real food in tube feeding routines. Thank you to all of our listeners.

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