Integrated & Community Services - Blended Diet by Gastrostomy

Shared decision-making document

Name:

NHS NO:

DOB:

This shared decision-making document has been developed to ensure that families have a good understanding of a blended diet and have considered the various different aspects of using successfully.

Consideration: Nutritional

Details: The need to dilute blended meals to achieve a suitable solution for administration. This will result in the need for larger volumes of feed to provide sufficient nutrition

Modifications: Liaison is required on an individual basis. It may be beneficial to use a combination of commercial formula and blended food, at least initially. Tolerance of volume should be closely monitored.

Discussed
 

 

Details: Blended meals may have a lower energy content than commercial formula.

Modifications: Monitoring of growth/weight should be undertaken. Information regarding suitable energy dense supplementation should be provided as appropriate to the individual.

Discussed

 

 

Details: The nutritional content of blended meals is not accurately known.

Modifications: Analysis of food diaries to enable assessment of nutrient intake may be needed, to identify any potential deficiencies or excesses of vitamins, minerals or macro or micronutrients. Supplementation may be required. This should be assessed on an individual basis.

Discussed

 

 

Specific nutritional aspects identified

 

 

Actions identified to overcome
 

 

Consideration: Infection

Details: Inappropriately or undercooked foods

Modifications: Awareness of food safety and hygiene guidance. See Food Standards Agency website (www.food.gov.uk)

Discussed

 

 

Details: Inappropriate storage of feeds

Modifications: Parent/Carer is aware of appropriate storage of prepared feeds
Feeds should be labelled with the date and time of preparing if sent to school/nursery or other setting.

Discussed

 

 

Details: Poor hand hygiene

Modifications: Promote good hand hygiene

Discussed
 

 

 

Details: Particles of food remaining in the tube after feeding

Modifications: Tube is to be flushed immediately after all feeds

Discussed

 

 

Details: Poor cleanliness of equipment used

Modifications: Liquidizer/blender and any other equipment is of a design which can easily be cleaned thoroughly.

Discussed

 

 

Specific nutritional aspects identified

 

 

Actions identified to overcome
 

 

Consideration: Feed Administration

Details: Thicker consistency of blended meals.
a)    It is unlikely that gravity bolus feeding will be practical
b)    Pump feeding is not recommended

Pumps are not calibrated for this consistency of feed. Blended meals may not remain in suspension for a prolonged period.

Increased infection risk from prolonged ‘hanging’ time

Modifications: Administration using syringe with plunger will be needed (caution relating to the pressure applied)

Discussed

 

 

Details: Potential uneven or over-heating of feed if parents prefer to give warmed feeds

Modifications: Avoid warming blended meal if possible. If refrigerated, remove from the fridge 20 minutes before administration to allow to come to room temperature.

If the blended meal is warmed, please refer to the Blended diet for Enteral Feeds leaflet.

Discussed

 

 

Specific feed aspects identified

 

 

Actions identified to overcome
 

 

 

Consideration: Tube Blockage

Details: Food being incompletely blended

Modifications: Ensure blended meals are completely smooth

Discussed

 

 

Details: Attempts to administer a solution which is too thick

Modifications: Flush tube immediately after all feeds

Ensure blended meal is adequately diluted to a suitable consistency. Review the tube type if necessary (ideally gastrostomy should be 12Fr or wider.)

Discussed
 

 

 

Consideration: Tube/device condition

Details: Devices other than buttons are not approved by the manufactures for the administration of blended feeds

Modifications: The patient or family member should be made aware of this

Discussed

 

 

Details: Earlier deterioration of devices or associated equipment could result

Modifications: The condition of the tube should be reviewed regularly by Dietitian, nurse or doctor.

Discussed

 

 

Details: Not suitable to be given via jejunostomy or nasogastric tube.

Modifications: Ensure feeding tube is appropriate for blended diet

Discussed
 

 

 

Details: Stoma tract must be mature before starting blended diet

Modifications: Ensure 8 to 12 weeks since tube placement before starting blended diet.

Discussed

 

 

Specific tube aspects identified

 

 

Actions identified to overcome
 

 

Consideration: Blends in other settings

Details: Other settings may not be able to accommodate a blended diet

Modifications: If admitted to hospital will need to follow hospital policy for blended diet.
If attends school/nursery will need to liaise with dietitian and setting as to whether a blended diet may be given.

Specific settings aspect identified:

 

 

Actions identified to overcome:

 

 

Copy to be given to parent/carer and copy added to patients notes