Integrated & Community Services - Blended diet for Enteral Feeds

Patient Name: ………………………………………………….

Date: ………………

Dietitian: ………………………………………………………..

Contact Number: ………………………………………………

Before using this leaflet, a Dietitian will have completed the Blended diet via gastrostomy shared decision-making document with you.

What is a Home Blended Diet?

Home Blended Diets are made by blending everyday foods into a thin puree, much like the consistency of single cream and then given through the gastrostomy tube. Blended family foods can be given alongside usual prescribed feeds or on their own, provided they meet nutritional requirements.

Blended diets are not suitable for all children/adults who are enterally tube fed. It’s unsuitable for those who are immuno- compromised or fed into the jejunum (e.g. via a jejunostomy). It is not recommended for those that are fed via a nasogastric (NG) tube. This is because NG tubes are thinner and longer than gastrostomy tubes, and splitting of the tube could lead to aspiration. For those with feeding tubes which cannot be easily changed, if they become blocked e.g., Percutaneous Endoscopic Gastrostomy (PEG), there needs to be a clear plan in place as to how to feed/ hydrate/ provide medication for the individual, in the event of a tube blockage. Balloon retained gastrostomies/ buttons can be replaced much more readily in the community.

What are the benefits of a Blended Diet?

Some parents and caregivers whose children have had problems with tolerance of prescribed feeds have found that their child can manage larger volumes of blended diet with some reduction in gastrointestinal symptoms, such as reflux and retching. An improved bowel function has also been reported.

What are the risks of a Blended Diet?

Tube Blockage – Blended foods need to be the correct consistency to pass easily through the tube.

Microbial Contamination – The risk of microbial contamination is significantly reduced if basic food hygiene principles are applied during food preparation and storage.

www.food.gov.uk/safety-hygiene/avoiding-cross-contamination

Nutritional Deficiencies – Some foods will need to have extra liquid added, to achieve the desired consistency for administration via the gastrostomy. If this increased volume causes problems with tolerance, an increase in frequency of the blends may need to be considered (4 meals and 2-3 snacks). Food fortification can be used to keep blends to a lower volume and higher energy density (See Blended Diet for Enteral Feeds Recipe leaflet).

Parent/caregivers may wish to complete an online food hygiene training course to minimise the risk of microbial contamination. The Food Standards Agency do not provide a food hygiene course or certificates, but The Local Authority may provide or recommend food hygiene courses.

Hand Hygiene

Wash hands thoroughly before, during and after preparation of foods. Take particular care when handling raw meat, poultry, eggs, or fish to avoid cross contamination of foods. This link provides more information on hand hygiene, bacteria & viruses, and cleaning of kitchen items

https://www.food.gov.uk/safety-hygiene/cleaning? navref=breadcrumb
 

Preparing Blended Food

For further guidance on getting the correct consistency for the blends, the IDDSI Framework and syringe test can be used. For more information, please use this link:

https://www.iddsi.org/IDDSI/media/images/ Complete_IDDSI_Framework_Final_31July2019.pdf

For smaller diameter tubes, it is likely that level 1 or 2 would be suitable, but not level 3 (moderately thick).

Equipment Needed

1.    Blender

High Speed Blenders – They can achieve a smooth consistency for most foods without the need to sieve the mixture. However, these blenders are more expensive.

Jug Blenders – These have blades at the bottom. Hand blenders can also be used but they will not be able to cope with all foods, especially raw foods. The mixture will need to be sieved before it goes through the gastrostomy button.

Blended diet can be trialled using commercial baby food purees (however these are low in nutrients so not for long term use), or with an inexpensive stick blender.

The purchase of a more powerful blender will increase the variety of foods which can be incorporated in the diet and enable batch blending.

The length of time blending is more important to achieve the correct consistency rather than the wattage (power) – 3-6 minutes per blend is recommended but this will vary depending on type of blender.

Sieving is recommended if a less powerful blender (like a stick blender) is used. This also helps if passing through a fine diameter tube or if using foods difficult to blend (foods with pips, seeds, grains, fibrous vegetables, meats). Nb. This may reduce the nutrition content.

The information below provides a summary:

Blender type: Stick Blender

Advantages: Inexpensive, easy to use and easy to clean.

Disadvantages: typically low power. Some foods are less easy to blend (eg seeds, nuts). Mainly small volumes. May be messy. A good container required to blend in. It may be necessary to use a sieve in addition.

Blender type: Mid-range eg Nutribullet, Nutri Ninja

Advantages: Mid-price range, easy to use, easy to clean, best for blending meal by meal, best with small volumes.

Disadvantages: Likely not large enough for batch blending. Durability.

Blender type: Commercial blenders eg Vitamix, Omniblend, BlendTec, Oster

Advantages: Powerful - will blend most foods. Good for batch blending and large quantities. May have self-clean settings. Long produce guarantee. Durable.

Disadvantages: Can be noisy. High initial cost.

2.    Weighing scales.
3.    Clean utensils and work surface to prepare food.
4.    Food thermometer.
5.    Sieve – a metal sieve is the best option.
6.    Empty re-sealable food storage containers and labels.
7.    60ml enteral feeding syringes to administer blends.

Safe Storage of Blended Foods

Storage after Preparation

The homemade blended foods can be refrigerated for to 24 - 48 hours. For safe storage of blends, the fridge temperature must be set between 1- 4 °C. After 48 hours any leftover feed must be discarded and not re-used.

1. Divide the blended diet into the required portions
2. Place in clean, airtight containers/resealable or Ziplock food bags
3. The blended foods should not remain at room temperature for more than 2 hours before refrigerating www.food.gov.uk/safety- hygiene/chilling
4. Label blends with a description, a “made on” and a “use by” date.
5. Blends must be used within 48 hours of preparation, or they need to be discarded.

Freezing Blended Foods

Alternatively, the homemade blended foods can be frozen; this should be done as soon as possible for safe storage. The freezer temperature must be set below -18°C and used within 1-3 months.

1. Divide the blended diet into the required portions.
2. Place in clean, airtight containers/ resealable or Ziplock food bags
3. The blended foods should not remain at room temperature for more than 2 hours before freezing.
4. Label blends with a description, a “made on” and a “use by” date.
5. Blends can be stored in the freezer for 1-3 months.
6. Defrosted blends stored in the fridge should be discarded after 24-48 hours, the same as freshly prepared blends.

Reheating

Blends that contain meat, chicken and previously cooked foods require reheating to 70°C for at least 2 minutes (‘piping hot’ or ‘steaming hot’) to kill off any bacteria. All other blends do not need reheating but should be brought to room temperature before administering by leaving out of the fridge for 30 minutes, or by placing the container holding the blend in warm water for 10 minutes.

Blends which are warm generally have a lower viscosity (less thick/ sticky) and reduce the risk of tube blockage. If the blend is too thick and it’s to be given immediately, a small amount of hot water could be added to reduce viscosity.

Blends that have been frozen should be thawed in the fridge below 5°C, heated (in accordance with information above) and used within 24-48 hours of removing from the freezer.

Before feeding allow the blend to cool to a suitable temperature i.e. body temperature 37°C/ a comfortable temperature if it was to be eaten by mouth. The food should not be too hot or too cold as it will be delivered straight into the stomach.

Blended foods should not stand at room temperature for longer than 2 hours because this is the optimal temperature for microbial growth which may lead to food poisoning.

Do not re-heat more than once.

Transport of blends

Ideally the blend should be kept at temperatures less than 5°C during transport and at school/nursery/day care, until ready to be given (to prevent fluctuating temperatures that could facilitate microbial growth).

A cool box and ice/gel packs, evenly distributed in the box could be used during travel. School/ nursery should have refrigeration capacity to store blends at the correct temperature and avoid cross contamination.

Labelling of the blends is very important to ensure the correct blend is given to the individual and that it’s discarded if it’s not used by the “use by” date. It is useful to list the ingredients on the label as well.

It may be useful to have an alternative available for emergencies e.g., commercial feed/ yogurt/ smoothie.

Domestic dehydrators

The use of domestic dehydrators should not be used due to increased risk of bacterial growth of food poisoning.

Administration of blends

See “Blended Diet Feed Care Plan.”

If the gastrostomy tube becomes blocked

Only water (cold or warm) can be used to try to unblock the tube. Administer a flush of water using a push/ pull action. A smaller syringe may help. This needs to be done carefully to prevent any tube damage. If the tube remains blocked, contact the Children’s Community Nurse Team (CCNT) for children and the Abbott Nurse Advisor for adults. (See contact details below). Always ensure a spare balloon retained gastrostomy travels with the child/ adult, so that it can be placed, if the blockage cannot be moved.

Monitoring the condition of the gastrostomy tube/ancillaries

The lifespan of the gastrostomy, extension sets and syringes may be affected by using blended diet. The devices are not currently approved for administration of blended food. This makes it important to regularly check they are still working correctly. They may need changing more frequently than usual.

Blended diet in other settings

Many care settings including hospitals and respite are now able to facilitate the use of blended diet. However, the decision whether to provide blended diet rests with the individual care provider. Blended diets may not be suitable if the individual is acutely unwell and needs oxygen, ventilation or is admitted to Intensive Care Unit or High Dependency Unit (ICU/PICU/HDU). The consultant in charge of their care can advise if they feel it is suitable for them to continue with blended diet.

Useful links/references

Practice Toolkit, The Use of Blended Diet with Enteral Feeding Tubes November 2021Accessed by www.bda.uk.com/static/ 33331d33-21d4-47a5-bbb79142980766a7/FINAL-Practice-Toolkit- The-Use-of-Blended-Diet-with-Enteral-Feeding-Tubes-
NOV-2021.pdf

https://www.iddsi.org/IDDSI/media/images/ Complete_IDDSI_Framework_Final_31July2019.pdf

https://www.food.gov.uk/safety-hygiene/cleaning? navref=breadcrumb

https://www.food.gov.uk/safety-hygiene/avoiding-cross- contamination

https://www.food.gov.uk/safety-hygiene/home-food-fact-checker

www.food.gov.uk/safety-hygiene/chilling

Contact numbers

Bury Children’s Community Nursing team 0161 724 2137

Rochdale Children’s Community Nursing team 0161 206 0606

Oldham Children’s Community Nursing team 0161 357 5115

Salford Children’s Community Nursing team 0161 206 2370

Abbott (24 hr helpline) 0800 018 3799 (to request an urgent call back from an Abbott Nurse Advisor).
Please note: Direct number for Abbott Nurse (office hours only) in your area may also have been provided by your Dietitian.