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

I am a Registered Dietitian who works with adults who have cancer. Part of my job consists of caring for individuals going through cancer treatments or those who have gone through rigorous cancer treatments, whether it be surgery, chemotherapy, radiation or combined modalities. Cancer and cancer treatments may cause unwanted and uncomfortable digestive issues for individuals such as diarrhea, constipation, heartburn, reflux, or nausea. This is where my professional journey with blenderized tube feeding started.

As a clinician, I have always been fascinated with enteral feeding and helping individuals who have feeding tubes. I began to become frustrated that some of my sickest patients who relied on enteral feedings as their primary source of nutrition were getting sicker and the traditional enteral formulas (specialty or not) did not seem to be working at a time when achieving optimal nutrition was critical for my patients during their cancer treatment. I was their dietitian and felt it was my duty to help them. I had seen various types of commercial blenderized products for feeding tubes out there and started to use them with my adult cancer patients and started to learn about them from other professionals, product representatives, my own research and by observing adults using them.

In the beginning, I primarily used blenderized tube feeding with my head and neck cancer patients who had gastrointestinal mucositis related to chemoradiation treatments. In meeting with patients who had feeding tube placements pending, many of them would ask what they could put through their feeding tube. I felt it necessary to discuss all options. I would often send samples of commercial real food blends products as a suggestion of another option for their feeding tube. These patients would often use them at various points during their cancer treatments.

I noticed improvements in tolerance by using real food products with enteral feedings. Some patients reported it made them feel more normal and felt less nauseated than formulas they had been on. Some reported less reflux and regular bowel movements. A lot of my patients started using them and then would use them supplementally with conventional formula, whether it be mixing the formula with the blended tube feeding or administering it separately. Some patients would use real food for one meal per day. I had one patient tell me she felt compelled to actually eat some of the commercialized real food products by mouth, something she hadn’t ever experienced being on tube feeding formula, despite being able to eat orally.

Blenderized tube feedings aren’t just for children, they can be appropriate for adults too, per healthcare professional recommendation. Real food tube feedings are appropriate for those who are one year of age and above, including adults. Many adults have feeding tubes for a variety of reasons. Beyond cancer, an adult may have a feeding tube for conditions such as gastroparesis, amyotrophic lateral sclerosis (ALS), poor oral intake, stroke, to name a few. It is important to educate and provide your patient with options available to them and potential benefits.

Blenderized tube feeding may help improve digestive issues such as bowel irregularities, reflux, and nausea. Some additional benefits may include decreased gagging/retching, digestive improvements, gut microbiome diversity, less oral aversion, weight gain and potentially less hospitalization1-3.

One study showed fewer hospitalizations with those discharged on blenderized tube feeding and required less inpatient, outpatient, urgent care and other visits, along with reductions in healthcare resource utilization compared to those on traditional tube feeding formula3.

Beyond these advantages, there are emotional benefits for those on blenderized tube feedings. Individuals may feel more mealtime connections and bonding because of active involvement in preparing meals. Individuals can have some control of food choices and may also participate in preparation of meals. More food choices provides more diversity. In addition, nutritious blended meals can cost less per meal than more specialized tube feeding formulas, resulting in savings and financial benefits for patients.

There are a variety of types of blenderized feeding types and methods of feeding. Think about yourself and how your diet varies from day to day. Imagine having a feeding tube and being told to do only one type of formula and water for your nutrition. For some, this may be appropriate and completely okay; however, some individuals do want to explore blenderized feedings.

Blenderized food can be given via syringe, gravity bag, or pump. When using gravity bags, it is helpful to use a large bore feeding bag. If using commercial blends, the blend will likely have to be diluted in order to make it thin enough to administer. Another device I find somewhat neat is the Bolee® bag. Similar to a pouch that you might use to give a child pureed food in, this device can offer a different way to administer a feeding.

Insurance coverage can vary for blenderized feedings. This topic is important for patients given the medical necessity of tube feeding. I think it is helpful to establish a relationship with someone at an infusion company or medical equipment company who knows about these matters. Registered dietitians can often help in these situations. Sometimes it will be requested to provide the reason why your patient needs to be on a real food product in order to justify insurance coverage. Nutricia Navigator is a helpful product coverage and access assistance program for patients, which may be contacted for free personalized one-on-one support in obtaining Real Food Blends®, a commercial blenderized tube feeding product. 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.

A lot of patients start exploring putting other things through their feeding tubes after starting a commercial blenderized product. Sometimes the commercial blenderized product can just be a suggestion and can be easier to start using, and sometimes patients might explore putting other things through their feeding tubes like smoothies, broths, protein shakes or juices. It doesn’t have to be 100% formula or a full blenderized tube feeding diet. It can be helpful for any patient on enteral nutrition to work with a registered dietitian who is knowledgeable in blenderized tube feeding so they can guide the patient and also discuss nutritional adequacy by looking at the whole tube feeding diet that patient is consuming.

For those adults living with a feeding tube, a lot are looking for what will work the best for them to feel their best and maintain their nutrition during whatever illness they have. Many long to eat again and are trying to process, adapt to and accept the fact that they cannot eat normally by mouth. We as healthcare providers can help them by offering all options of enteral feeding that will help them be successful in so many different ways.

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.on C