By Whitney Christie, MS, RD, CSO, CNSC, FAND

Blenderized tube feeding can be a worthwhile method to explore for those doing home tube feedings. Studies have shown that blenderized tube feedings result in less gagging/retching, digestive improvements and diversifying the gut microbiome^1-3. Using real food through a feeding tube has also been shown to decrease oral aversion, increase weight and lessen hospitalization². Other benefits include offering a way to increase mealtime connections, emotional support, control of food choices and participation in preparation of meals.

Many people think blenderized tube feeding looks and seems hard (initially, these were my thoughts too). Although blenderized tube feeding may require some meal planning and preparation, it has its benefits. Commercial blenderized tube feeding can also simplify the process. If you haven’t yet heard of or tried blenderized feedings, here are a few things to know and tips on mastering the art of putting real food through your feeding tube.

What is Blenderized Tube Feeding?

In short, blenderized tube feeding involves taking real foods and using them through a feeding tube, either as a supplement to your nutrition you take by mouth or as a way to provide all of your nutrition. Blenderized feeding in its simplest form can involve putting fruit juice down your tube or you can use a blender to prepare your daily meals from one meal a day to all meals during any given day. Blenderized tube feeding can go through G-tubes, J-tubes and even NG tubes. Always discuss administration with your healthcare provider, and need for additional vitamin/mineral supplementation as needed.

How to Get Started

If you’re worried about clogging your feeding tube, you aren’t alone. This is a valid concern for someone thinking about blenderized tube feeding, but can be solved through proper technique, administration methods, and G-tube care. In order to start blenderized feedings, a 14-French Feeding tube is recommended, although tubes with French size as small as 10-French have been used for blenderized tube feeding. Medications, particle size of the food blend, and flushing technique may also play a factor in feeding tube clogs¹.

Equipment Needs

Knowing what equipment to use can also help with being successful with putting real food through your feeding tube. It can be difficult to do a syringe feeding using a traditional gravity method with real food feedings. A manual push method using a feeding syringe can be another option. O-ring syringes are helpful for tube feeding real food blends when other plunger types may stick. Lubricate the feeding syringe with olive oil or butter to help make pushing the blend easier. If you are packing your lunch, traveling to multiple doctors visits or just want to make it easier on yourself at home, consider drawing up blenderized feeding in several syringes for a quicker, less time-consuming (and possibly messy) feed. For easy transport, throw them in a bookbag with an ice pack and go.

Gravity Bags

For those using gravity bags, you will need to request large bore gravity bags. Some find challenges even with large bore gravity feeding bags and often require a thinner blend (which may mean using lots of fluid to thin out the mixture). Dietitians can be a great resource to help troubleshoot tube feeding and review any adjustments you’ve made in things like fluids and provide input (or another perspective) if needed. Blenderized tube feeding is a process that you are not going to be perfect at initially. It takes time and often trial and error to find a system and routine that works for you. DMEs may also provide these for you¹.

Bolee® Bag

Bolee bags are a newer, innovative feeding system where reusable tube feeding pouches help administer feedings (you can even obtain samples of them if you inquire with your healthcare provider). The pouches can be used multiple times (up to 15 uses). I often have patients who prefer to use these when they have administration challenges with gravity bag feeding their blends.

Button or Low Profile Feeding Tubes

For those with a button tube, straight bolus extension sets are needed¹. Talk to your homecare or the company that provides your tube feeding about this. If you are using a tube feeding pump, it is best to discuss with your nutrition support professional or homecare company. Blenderized tube feedings can be administered using a tube feeding pump but there may be adjustments that are needed with either the tube feeding pump or the blenderized product that are necessary.

Blender Considerations

Now let’s talk about the fun part…. making that blend! Making or mixing your blend will involve the use of a blender. Blenders range from professional, to jug or wand style. Professional blenders are often stronger with a high-powered motor, extended warranty and may work better for those requiring blenderized tube feedings for a longer length of time. A typical blend takes 3-6 minutes of blending time (or more if you want to decrease particle size of the blend)¹.

Types of Blenderized Tube Feedings: Homemade Versus Commercial

There are various ways of utilizing blenderized tube feeding into your daily routine. Homemade and commercial preparations each have various benefits. It is also important to remember that you can also do both homemade and commercial blends together. Your nutrition doesn’t have to be limited to one type of blenderized feed (people who normally eat food by mouth often do not have the same exact foods at the same time every day). This is one of the beauties of using blenderized products as they offer more variety and options than traditional formulas.

Homemade formulas can be done on the spot and a blender can be used at the time of meal prep. Some prefer to make large batches ahead of time and use them in the future, following food safety practices. Tips for homemade blenderized feeds would be to consider having airtight containers for freezing, freezer space and refrigerator space for thawing. A combination of these methods can also happen.

Commercial products offer an easy, convenient way to start the blended tube feeding journey. These are formulas manufactured with food ingredients or pureed foods that may or may not have added vitamins and minerals. You will also need to have adequate space to store these (most homecare companies send a month’s worth of formulas at a time). Insurance is variable for commercial blenderized tube feedings so talk with your durable medical equipment (DME)/homecare or infusion company as additional documentation may be needed for coverage or what blenderized products they have that might be an option for you. A registered dietitian can also help navigate this with you. Nutricia Navigator is a helpful product coverage and access assistance program, which you may contact for free personalized one-on-one support in obtaining Real Food Blends meals. Real Food Blends® offers 100% real food meals with no synthetic ingredients, and most closely mimics homemade blenderized tube feeding compared to other blenderized enteral products.

If making homemade blends, foods that increase the risk of tube clogging include white pasta, white rice, breads, muffins and bagels, uncooked protein sources, meats, seafood, beans/legumes, eggs, flaxseed, olives, celery, string beans, and fruits with skins¹.

Sieving is a process where utensils (typically with a mesh/wire strainer (or cheesecloth) separate coarse food particles, separating solids from liquids or reducing soft solids into a pump.  Sieving can take away a significant portion of the nutritional value of a food so limit using a sieve for removing seeds and stems¹.

Hang Time

You want to discard any commercial product within 24 hours after opening and hang time for commercial products varies depending on the product.

For homemade blends, hang time is no greater than 2 hours. And it is recommended to discard blends after 3-4 days if they are not frozen. Make sure you are freezing prepared blenderized tube feeding within 24 hours of making¹.

In conclusion, blenderized feeding can seem intimidating at first but hopefully some of these pointers can make the journey a little easier for you and allow you to experience a world of possibilities and benefits. Always work with your healthcare professional when making changes to your tube feeding plan at home.

Whitney Christie is a consultant for Nutricia North America and has been compensated to write this blog post.

References:

1. Epp L, Blackmer A, Church A, et al. Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition. Nutr Clin Pract. 2023;38(6):1190-1219. doi:10.1002/ncp.11055
2. Schmitz ÉPCR, Silva ECD, Lins Filho OL, Antunes MMC, Brandt KG. Blenderized tube feeding for children: an integrative review. Rev Paul Pediatr. 2021;40:e2020419. Published 2021 Sep 1. doi:10.1590/1984-0462/2022/40/2020419
3. Desai et al. Real-World Evidence on Clinical and Health Economic Outcomes among Adults Patients in Post-Acute Care Receiving Commercial Blenderized Tube Feeding Formulas. JPEN. 2023; 47(52):S104.