In this post, I’ll be sharing three tips and tricks that I hope will help you have success when using a feeding pump for your blended diet meals.
# 1: Laying the Bag Flat
One of the difficulties of using a pump for blenderized tube feeding is that small particles of food can get stuck in the tubing, or cause a blockage at the exit point of the bag. When this happens, your pump will beep and stop pumping. Depending on your pump, you may see a flow error message. This situation can be quite a hassle to deal with. You may need to empty the bag, try to wash it out (more on that later), strain the blended meal, put your meal back in the bag and re-try. If a piece of food is stuck in an impossible-to-reach spot, you may have to throw out that bag and start again with a new one.
I learned a trick from one of my adult patients that can really help prevent this problem-- Most people are instructed to hang their feeding bag in a vertical position. As pictured below, any food solids will fall to the bottom of the bag and block the exit from the bag into the tubing causing a blockage (note that for demonstration purposes I created a very inappropriately lumpy under-blended blend of water, blackberries, raspberries, blueberries and almonds).
The trick is this- instead of hanging the bag vertically, simply lay it on it’s side on a table or any flat surface, making sure that the tubing exit point is slightly higher than the bag (see photo above). Once you have it in this flat position, leave it for a few minutes and then start the pump as usual. Any large food solids will fall to the bottom of the bag and not block the exit of the bag. As long as you’ve primed the bag and tubing to remove all air, the pump will work to feed all the blended food, leaving behind any bits of food in the bottom of the bag.
Keep in mind that for this to work, you need to allow enough time for the solids to settle to the bottom and the bag needs to stay still for the duration of the feed. This trick is unnecessary if you simply avoid hard/seedy foods, run your blender long enough to break everything down, or just strain your blend to remove any bits of remaining food.
# 2: Clipping off the Plastic Tab
As I said in Part 1, I am most familiar with the Kangaroo Joey pump and the Enteralite Infinity pump for home tube feeding. Both the Kangaroo Joey and the Enteralite Infinity are great pumps. My preference for blenderized tube feeding is the Infinity pump because in my experience it works really well with blended food and can manage thicker blends than the Joey (plus the Infinity sets are much easier to clean). That said, there is a little trick that makes a big improvement to the performance of the Infinity pump when using blended food.
Take a close look at the area of flexible teal tubing on the Infinity feeding set. If you look closely, you’ll notice that on one side, the teal tubing has a faint outlined image of a drop and the teal tubing is slightly longer. The teal tubing can be detached from the hard clear plastic on both sides (see photo below). This exposes two hard clear plastic tubing tips.
Notice that the hard clear plastic tubing has a little tab on the tip (only on the side of the teal tubing that is slightly longer and has the outline of the drop image). Food needs to make a 90 degree turn and pass through the tiny side holes in the hard plastic tubing below the tab. Understandably, food is likely to get caught at this point, causing the pump to beep and stop working.
In order to get a better flow of food and reduce the risk of blockage at this point in the feeding set, remove this plastic tab. To do so, take a pair of strong scissors and simply cut off the tab. Then, replace the teal tubing into its original position and proceed to use the feeding set like usual.
# 3: Reusing Feeding Sets
Home tube feeding involves a lot of supplies. Those supplies are expensive and not necessarily covered by insurance. In my area of Canada, the feeding pump bags cost about seven dollars each. The manufacturer states that the feeding sets should be replaced every 24 hours. If you follow this practice, the cost of the sets will be over 200 dollars each month. Aside from the expense, many people have concerns about the environmental impact of so much discarded plastic.
In my opinion, a feeding set isn’t all that different from a plate you would use for meals when eating by mouth. We don’t use the same plate for 24 hours and then throw it in the garbage and use a brand new plate the next day. We wash our plate after each meal and reuse it for future meals. In theory, you can do the same thing with a tube feeding set. By using warm water and dish soap you can clean out the sets in your kitchen sink. The difficulty is that it can be hard to clean feeding bags and tubing thoroughly. The tubing is hard to rinse out and may never dry completely, allowing a moist environment for bacterial growth.
Through my own experimentation and discussion with my patients, I’ve found that the feeding sets for the Kangaroo Joey pump are very difficult to clean. In fact, it’s nearly impossible to flow anything through the tubing when bag is detached from the pump. I’ve even tried to take apart the tubing and squeeze water through, but this is nearly impossible unless the dial is in a very specific position, and even then it’s a very hard task.
Cleaning out the Joey bag isn't particularly difficult (just rinse out the residue from the blend and swish soapy water around and dump it out from the top), but unfortunately it's difficult to flow soapy water through the Joey tubing. The simplest way to clean the tubing is to fill the bag with warm soapy water and set it up on the pump. Then, set it up at the highest infusion rate and leave it to flow into your sink. Once it has run through, set it up again with clear water and run it again to rinse the tubing. This is how I clean the Joey sets and I find it to be quite a hassle and very time consuming. I’ve also found that depending on the ingredients of my blend, the bag and tubing may not be entirely clean, even after running soapy water through the pump for an hour. I think that even at the highest infusion rate, the amount of force from the pump just isn’t enough to get the tubing perfectly clean. For this reason and others (see Part 1), I don’t recommend the Joey pump to my patients who have a blended diet.
Luckily, the Enteralite Infinity pump works really well with blended food and the feeding sets are very easy to clean. Again, all you need is warm water and dish soap. The first thing to do is remove both ends of the flexible teal tubing from the hard clear plastic in the middle section of the feeding set. Now you can easily rinse out the bag and squeeze soapy water from the bag into the tubing until everything is perfectly clean. Also, try to flow water into the distal tubing until it’s as clean as possible. Always rinse everything out with clear water to remove any soapy residue. This cleaning process is quite easy and that is one of the reasons why I prefer the Infinity pump for home tube feeding. There's less hassle, better hygiene and less cost due to longer use of the feeding sets.
Regardless of what pump you use -- store washed bags in the refrigerator. In doing so, you will limit bacterial growth in the bag's tubing and keep your feeding set in better condition for longer. Don’t keep feeding sets for longer than seven days as by that point they’re likely to be well used and may have bacteria in the pores of the plastic.
I hope you’ve found these tips and tricks useful. If you have a tip or trick you’d like to share, leave me a comment here or on Instagram, or email me. Remember, the content of this blog represents my personal opinions and experiences. Tube feeding is complicated and must be individualized. Always follow the guidance of your own medical team and do not make changes to your tube feeding plan without consulting your doctor and/or personal dietitian.
Thanks for reading!