Understanding Ensure Plus for Tube Feeding
Not all Ensure Plus products are the same, and the suitability for tube feeding depends on the specific formulation. While the standard, ready-to-drink oral supplement should not be poured directly into a feeding tube without explicit medical instruction, certain versions are specifically engineered for this purpose. These specialized products, such as Ensure Plus RTH (Ready-to-Hang) or Ensure Plus HN (High Nitrogen), have a controlled viscosity and are packaged for direct connection to enteral feeding equipment, minimizing the risk of contamination and tube blockages.
Which Ensure Plus products are safe for tube feeding?
- Ensure Plus RTH: This is a key product formulated for enteral nutrition. It comes in a sterile, ready-to-hang container designed for immediate use with a feeding set. It is calorically dense (1.5 kcal/mL) and provides complete, balanced nutrition.
- Ensure Plus HN (High Nitrogen): Another suitable option, Ensure Plus HN is a high-energy tube feed designed for patients with increased protein needs. It is also ready-to-use and often fiber-free.
- Oral Ensure Plus: The standard, ready-to-drink bottles sold for oral consumption are not designed for tube feeding. The viscosity and packaging are not optimized for this use and can lead to clogging and contamination.
Proper Administration for Tube Feeding
Using Ensure Plus in a feeding tube is a medical procedure that requires precise technique to avoid complications. Here is a general guide, which should always be reinforced by a healthcare professional's specific instructions.
- Preparation is Key: Always wash your hands thoroughly before handling the formula or feeding equipment. Check the product's expiration date and inspect the container for any damage.
- Shake Well: Before use, the container of Ensure Plus RTH must be shaken well to ensure the contents are thoroughly mixed.
- Connect Immediately: Connect the feeding set to the ready-to-hang container immediately prior to starting the feed. This minimizes the exposure of the formula to air and potential contaminants.
- Administer at Room Temperature: The formula should be administered at room temperature. Cold formula can cause gastrointestinal discomfort.
- Adjust Flow Rate: The flow rate and volume should be set according to the patient's nutritional needs and tolerance, as determined by a healthcare provider.
- Flush Regularly: To prevent blockages, flush the feeding tube with the recommended amount of water every four hours during continuous feeding, as well as before and after intermittent feedings and medication administration.
Risks and Considerations
Using a nutritional supplement via a feeding tube is not without risks, which is why it must be done under medical supervision. Key risks include:
- Tube Blockage: Thick formulas or dried residue can clog the tube. Proper flushing and using ready-to-hang formulas specifically designed for tubes are the best preventative measures.
- Contamination: Improper handling or storage can lead to bacterial growth in the formula or feeding equipment, increasing the risk of infection. Always discard unused portions within the recommended timeframe, typically 24 hours after opening.
- Gastrointestinal Issues: Patients may experience side effects such as diarrhea, bloating, cramping, or nausea. A healthcare provider should be consulted to adjust the feeding regimen if these occur.
- Aspiration: If the formula is regurgitated and enters the lungs, it can cause aspiration pneumonia. This is a serious risk that can be mitigated by keeping the patient's head elevated during and after feeding.
Comparison: Ensure Plus RTH vs. Standard Enteral Formulas
| Feature | Ensure Plus RTH | Standard Hospital Formula (e.g., Jevity 1.5) | Specialized Formula (e.g., for trauma patients) |
|---|---|---|---|
| Primary Use | Provides concentrated calories and protein for weight gain or maintenance; ideal for fluid-restricted patients. | Standard enteral feeding for routine nutritional needs. | Formulated for specific clinical needs, such as managing inflammation or improving immune function in critically ill patients. |
| Composition | High protein (1.5 kcal/mL), often fibre-free (HN version), with medium-chain triglycerides (MCTs). | High protein, calorically dense, and often fiber-containing. | May contain specific immuno-nutrients (e.g., glutamine, arginine) or fiber designed for targeted outcomes. |
| Availability | Widely available, with specific ready-to-hang options readily accessible from medical suppliers. | Common in hospital settings; specific formulas are chosen by dietitians based on patient needs. | Often prescribed for specific patient populations, based on evidence-based protocols. |
| Medical Supervision | Required. Use under medical supervision to determine suitability and manage risks. | Required. Prescribed and managed by a healthcare team. | Required. Use is guided by clinical trials and specific medical protocols. |
Conclusion
Using Ensure Plus for tube feeding is a viable and often-recommended option, but it is critical to use the specific, ready-to-hang (RTH) versions designed for enteral use. Never use the standard oral supplement, as it can cause tube blockages and increase infection risks. Always administer the formula under the guidance of a healthcare professional who can determine the appropriate product, flow rate, and volume for the patient's specific nutritional needs. Proper hygiene, careful administration, and consistent flushing are essential practices to ensure safety and effectiveness. By adhering to these guidelines, patients can receive the full nutritional benefits of Ensure Plus via tube feeding while minimizing potential complications.
For more detailed information on specific products and clinical guidelines for enteral nutrition, refer to resources from reputable organizations. The Canadian Cancer Society offers useful information on tube feeding side effects and risks.
