I’ve written this piece from the perspective of a community dietitian that is looking after a patient on home enteral nutrition (i.e., home tube feeding). However, if you are someone with a feeding tube or a carer for someone with a feeding tube, equipment terminology would be handy for you to know as well. Knowledge is power! Let’s get started.
Who makes tube feeding equipment?
In Australia, the main enteral feeding equipment companies are: Nutricia, AMSL, Cardinal Health, and Avanos. Why do you need to know this? To set yourself and your patient up for successful home enteral nutrition support! Knowing what brand your patients tube feeding equipment is and who the representative from that company is, means they can help you in the following way: 1) prepare quotes for NDIS or any other insurance schemes, 2) source an adaptor you really need to make the feeding process easier, 4) find a shorter extension set so your patient isn’t holding the syringe up very high to feed, 5) find the right giving set for the type of formula your patient is on, and many other things! With my patients permission, I sometimes send company representatives photos of my patients feeding tube so I make sure we find the exact piece of equipment needed for their tube.
Where can I get tube feeding equipment from?
You can either go straight to the company, or there are many medical equipment suppliers around such as Bright Sky and Independence Australia. Generally, the rule of thumb is to go to the company first, however, if someone gets all their other supplies such as continence pads from, for example, Bright Sky, it will save them delivery fees and time to just put their enteral feeding equipment through Bright Sky as well.
What equipment does my patient need if they are on home tube feeding?
In short: giving sets, extension sets, syringes, empty containers, pump, IV pole, gastrostomy belt, and adaptors. For the eager beavers wanting to understand each of them, keep reading.
- Giving sets: This is the tubing that goes from the formula bottle to the feeding tube. Examples of the several types of giving sets can be found here. Giving sets are needed for those on pump feeding or gravity drip feeding. Below are the features you need to know about. Make sure you find out from the referring hospital exactly what features your patient’s giving set has.
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- Spike or bottle set: Giving sets connect to a formula bottle either by a spike or a bottle cap. Make sure you check the mouth of the formula bottle your patient is on before choosing which giving set they need.
- Y-port: Having a y-port or medication port is useful if the patient is on non-stop continuous pump feeding and medications need to be incorporated in the feed. This is highly unlikely in the home tube fed population who are usually on intermittent feeding via syringe or pump; so, there are times between feeding for medication administration through a syringe straight into the feeding tube.
- Roller clamps: Control the feed rate. When the roller is fully up this stops the feed, halfway slows the rate down, and fully down allows the feed to run with gravity. Not necessary for home tube fed population.
- Drip chambers: Mainly for patients on continuous gravity drip feeding, which is unlikely in the home tube fed population.
- Extension sets: For patients with a low profile “button” gastrostomy tube, they need an extension set to connect to their button gastrostomy tube and then to the syringe or giving set depending on whether they are on bolus syringe feeding or pump/gravity drip feeding, respectively. Extension sets differ in length (in cm) and in number of ports (generally between 1 – 3 ports where one might be for feeding, one for water, and one for medications). It’s always a good idea to make sure the extension sets purchased are from the same company of the actual button gastrostomy tube. Extension sets can also come as right-angle connectors or straight connectors. Example here.
- Syringes: ENFit syringes come in all sizes such as 10ml, 20ml, 50ml, 60ml, etc. Generally, for syringe bolus feeding, a large 60ml syringe is most efficient. It’s important to note that syringes come either as single use or reusable. For the home tube fed, get the reusable ones and one syringe lasts 7 days. So, patients will only need 4-5 syringes a month. Example here.
- Empty 500ml or 1L container or gravity bag: When patients need to decant their formula and then hang it up for either pump or gravity drip feeding, it’s best to decant into a 500ml or 1L container or bag. Nonetheless, I often try to avoid this practice of decanting as it can introduce bugs into the enteral system. Example here.
- Pump: I won’t go into what pumps are as the word is self-explanatory. But I will say that every pump company has a manual of how to operate the pump. Get that manual and make sure you hand it to your patient. And remember that pump companies often have phone or in-house support that they provide to patients using their pumps. You are never alone!
- IV pole: At Tube Dietitian, we are huge advocates for The FreeArm and believe this is a perfect solution for any of your patients on pump feeding. Forget bulk ugly-looking tall IV poles. The FreeArm is colourful, portable, and effective.
- Gastrostomy belt: Instead of having a gastrostomy tube hanging loose, why not consider a belt to hold it in place? Example here. Not a must have but an option.
- Adaptors:
- Transition adaptors are used to connect an ENFit ended syringe or giving set to a non-ENFit ended feeding tube, or vice versa. Ideally, both the syringe/giving set and feeding tube would be ENFit ended and so they wouldn’t need an adaptor but that doesn’t always happen as old feeding tubes may still be inserted in some patients at some hospitals. Example of a transition adaptor – here.
- Some gastrostomy tubes have replaceable y-port adaptors that can be renewed every so often rather than having the whole tube replaced. Example here.
- If you’re wondering what ENFit is, it is an international standard that was mandated in 2016 with an aim to have all enteral feeding equipment with a unique twist design dissimilar to IV and catheter connections to reduce the risk of tube misconnections. For more information about ENFit, click here.
I hope that helps somewhat decode the mysteries of tube feeding equipment! Any suggested additions, please get in touch. If you’re after information on actual feeding tubes, check out this blog post.
Happy reading and home tube feeding.
Tube Dietitian.