There are 3 methods of tube feeding blended food: pump, gravity and syringe. I've already written a blog post all about pump infusion of blended food, so take a look at that if you’re interested. In this post I’ll be going over syringe feeding in detail, including why syringe feeding is a good option for tube feeding blended meals.
Tube Feeding By Syringe
Whenever possible, I prefer to set up my home tube feeding patients with syringe feeding rather than pump or gravity infusion. Of course, I always present all three options and discuss the pros and cons of each, but I do tend to encourage syringe feeding for people who are good candidates. Some people decide to do a combination of methods and that is absolutely fine. The aim is to find what works best for each individual and their family.
Who Is A Candidate For Syringe Feeding?
When a person is able to tolerate bolus feeding (meals vs continuous infusions) delivered by pump or gravity, they usually tolerate syringe feeding too. Tube feeding by syringe involves the infusion of food or formula into the tube by pushing on the plunger of a filled syringe. The plunger can be pushed very slowly or very quickly. I advise that aiming to take about 10 seconds to push the contents of a full 60 mL syringe into the feeding tube is an appropriate rate for most people. With syringe feeding, food or formula passes quite quickly into the tube compared to the other feeding methods. I’ve seen adults syringe feed as much as 600 ml of formula in as little as 15 minutes. It sounds ridiculously fast, and it is, but if you think about how much an adult can comfortably eat in one sitting, it's not as surprising.
Because of this fast infusion, syringe feeding is a good option for people who have a feeding tube in gastric position (tip of tube in the stomach), are able to tolerate bolus tube feeding (feel fine when fed large amounts of food or formula at one time), and are okay with the effort of using a syringe (some people don’t have the time or energy to repeatedly fill and attach syringes to the feeding tube). There are cases where syringe feeding works well for people who have feeding tubes in a jejunal position, but generally pump infusion is better tolerated into the small bowel. Everyone is different so it’s important to talk to your healthcare team about the various options and find what works best for you or your tube fed loved one.
Potential Benefits Of Syringe Feeding
Syringe feeding is the most inexpensive way to provide tube feeding because feeding bags aren’t required and you do not need a pump. Pumps are very expensive to buy and the cost of the disposable pump feeding bags or gravity bags adds up to a lot of money over time. For syringe feeding, all you need is a syringe, and syringes are cheap. Syringes can be washed and reused over and over again, so their cost per use can potentially be very low, particularly if you use a long-lasting syringe, such as an O-ring syringe (more on O-ring syringes later in this post).
Syringe feeding is also the simplest and easiest tube feeding method. All you have to do is draw up blended food into the syringe and then attach it to the feeding tube and slowly infuse it by pressing down the plunger. The other way to administer tube feeding by syringe is the “funnel method” where you remove the plunger from the syringe and attach it to the feeding tube and then slowly pour thin fluid or water into the syringe. This method doesn’t work with thick blends and some people find that even thin fluids don’t necessarily flow down their tube. So, the funnel method may be worth a try, but keep the plunger handy and revert to the plunger push method if needed.
Syringe feeding is also advantageous for people with busy lifestyles. It’s the most convenient option for feeding when you’re on the go because you only need to bring along a syringe, food (or formula), and a bottle of water for flushes and hydration. Since syringes are relatively small, they fit into car glove compartments, purses, backpacks etc, so wherever you go, you should be able to have a syringe on hand for feeding.
Finally, with syringe feeding you don’t need to spend as much time cleaning up feeding bag sets. All that cleaning up gets tiring after a while, so this is a big benefit for some people. To clean a syringe, all you have to do is take out the plunger and wash the syringe and plunger in warm water, using dish soap, as you would any cooking utensil or dishware. Air dry. That’s it. Syringes can go in the dishwasher but that will cause them to wear out more quickly than if they are hand washed.
Disadvantage of Syringe Feeding
Syringe feeding required repeated drawing up of food or formula into the syringe. Some people find this process very tedious, particularly if they need to consume a lot of food or formula in order to meet their nutrition needs, For example, if a parent needs to feed their child about 600 mL of blended food each day, that's about 10 full 60 mL syringes, plus the water flushes before and after each feed. That's not too bad and wouldn't be terribly time consuming. However, if you are an adult who needs 3000 mL of food each day, that's 50 full 60 mL syringes! 50 times drawing food up into the syringe and attaching it to the feeding tube and pressing the plunger. I consider this a big potential drawback of syringe feeding, but there are some ways to get around this.
If you have trouble using a syringe or if you dislike the repeated process of syringe feeding, there may still be options for you. One option would be to use a syringe that is easier to use, such as an O-ring syringe (more on that later in the post), or a larger volume syringe (like this 200 mL option) so that you don’t have to do as many syringes to get in your nutrition. Remember, you can always do a combination of feeding methods, for example, use a syringe for breakfast and lunch, but use a pump in the evening. It's all about finding what works best for you.
Syringe Feeding a Blended Diet
When it comes to blenderized tube feeding, syringe feeding offers some unique benefits. Anyone who has tried using a pump or gravity infusion for blended food will know that there are challenges. If the blend is too thick or has any unblended food particles, the odds are high that there will be a problem. Nothing is more frustrating than when the pump alarms due to a flow problem or the gravity flow stops mid-feed due to a blockage in the feeding set tubing. Troubleshooting these problems can be very time consuming and sometimes results in the feeding bag needing to be thrown out and starting all over again with the meal. Although this can be avoided by using thinner blends, straining blends and making alterations to the pump bags (read my blog post where I share my tips for using a pump for blenderized tube feeding), there is still some stress involved.
Luckily, syringe feeding is much more forgiving. With syringe feeding, thick blends can be fed. Although you don’t want an overly thick blend, it’s generally better to have a thicker texture for 3 reasons. 1) Thicker blends are less likely to cause reflux 2) Thicker blends are slower to empty from the stomach so a person feels satisfied for longer 3) Thicker blends are usually higher in nutrition than thin blends.
How do you know if a blend is too thick for syringe feeding? That’s easy. If it’s too thick to draw up into your syringe, it needs to be thinned out. Similarly, if you have trouble drawing up a blend into a syringe because there are particles of food that are blocking the syringe tip, this is a clear sign that the food has not been properly blended and needs to be blended for longer and/or strained. Blends that have small particles of food that are small enough to be drawn up into the syringe without difficulty are ok to be fed. The syringe tip opening is about 12 French, so as long as the feeding tube is at least 12 French in size (learn about French sizes here) particles of food that are small enough to be drawn into the syringe would be too small to block the feeding tube when fed.
Environmental Impact of Syringes
In the hospital, inexpensive plastic syringes are used for tube feeding medication administration, water flushes and sometimes administration of tube feeding. These syringes are thrown out, in the garbage, every day. In the home setting, syringes can be reused. They should be washed with soap and warm water and left to air dry after each use. Some people are able to reuse their syringes for quite some time before they stop functioning well, while others find that after only a few days their syringe is too stiff and sticky to use. Adding a drop of an edible oil (ex: olive, canola or coconut) to lubricate the barrel of the syringe may extend the life of the syringe, but sooner or later it will become too stiff to use. When syringes need to be replaced every few days, that’s a lot of syringes going to the landfill and a lot of money spent on syringes.
There are a couple solutions to this problem. One is by using a syringe that is not designed to be disposable, like this stainless steel syringe which can be used over and over again. I personally haven't tried the stainless steel syringe but I have heard good things about it overall, but there are some people that are uncomfortable with not being able to see the inside of the syringe (because it's metal, not clear plastic).
Another option is to use a long lasting syringe like O-ring syringes. O-ring syringes are high quality plastic syringes that are designed for long term use. The silicone O-ring means that the plunger slides easily, making the syringe easier and more enjoyable to use. For anyone who has hand dexterity issues or weakness, O-ring syringes are a great option to make syringe feeding easier. The other great benefit is that this type of syringe is extremely long lasting compared to standard tube feeding syringes.
I have been amazed by the longevity of O-ring syringes. As an example, after receiving samples of the Basik O-Ring syringe, I gave 3 to a person on home tube feeding because I knew that they were frustrated with using standard syringes. They used those 3 syringes for over 9 months! The standard syringes were only lasting them a few days. After 9 months of use, they reached out to me to see where they could get more of the Basik O-ring syringes because they were finally wearing out. It’s truly impressive how long these syringes can last and I recommend them wholeheartedly to anyone looking for a better syringe for tube feeding.
Thank you so much for reading this post. Remember, if you're interested in starting a blended diet for your tube feeding or your loved-one's tube feeding, check out the Natural Tube Feeding Recipe eBook.