Understanding Blenderized Tube Feeding
Blenderized tube feeding (BTF), also known as a pureed-by-gastrostomy-tube (PBGT) diet, involves the administration of pureed whole foods through a feeding tube directly into the stomach. This method is a growing alternative to commercial formula and can include a wide variety of foods, from fruits and vegetables to lean meats and grains. The appeal of BTF often stems from the desire for more natural, less processed nutrition and the potential to improve a patient's overall gastrointestinal health. For many caregivers, especially those feeding a loved one with chronic health issues, preparing homemade blends provides a sense of normalcy and control over the diet. However, the process requires careful consideration and planning, always in consultation with a registered dietitian and medical team.
Benefits of Blenderized Tube Feeding
Beyond providing nutrition, BTF has several potential advantages over commercial formulas, particularly for individuals with specific tolerances or sensitivities. Some of the most frequently cited benefits include:
- Improved Gastrointestinal Symptoms: Numerous studies have shown that patients on BTF experience reduced gagging, retching, reflux, vomiting, and altered bowel habits such as constipation or diarrhea. This may be due to the increased viscosity of the blended meal, which can slow gastric emptying.
- Better Gut Health: A wider variety of foods and nutrients can help promote a healthier, more diverse gut microbiome, which is not typically achieved with standard commercial formulas.
- Increased Oral Tolerance: In children with feeding disorders, a BTF diet has been shown to increase their interest in oral eating, potentially helping with the transition from tube feeding to oral consumption over time.
- Tailored Nutritional Needs: Homemade BTF allows for highly personalized recipes that can accommodate specific food allergies, intolerances, or dietary preferences.
- Psychological Well-being: The ability to provide "real food" can be psychologically beneficial for both the patient and their family, fostering a more positive feeding experience and promoting inclusion at family mealtimes.
Risks and Challenges of Pureed Feeding
Despite the benefits, it's crucial to acknowledge the challenges associated with administering pureed food through a G tube. Key risks and drawbacks include:
- Tube Blockage: The most significant risk is clogging the G tube with improperly blended food. A tube size of 14 French or larger is often recommended for BTF to minimize this risk. Foods containing seeds, fibrous parts (like celery strings), or thick skins can be particularly problematic.
- Nutritional Imbalance: Creating a balanced, nutrient-dense blend can be time-consuming and requires expertise. A poorly planned BTF diet may lead to nutritional deficiencies in calories, protein, or specific micronutrients. Regular monitoring by a dietitian is essential to prevent this.
- Food Safety and Hygiene: Improper handling, preparation, and storage of homemade blends can increase the risk of foodborne illness. Unlike sterile commercial formulas, homemade feeds are susceptible to microbial contamination if not handled correctly.
- Inconvenience: Preparing, portioning, and storing homemade blends requires a significant time commitment, which can be challenging for busy caregivers.
- Administration Method: BTF is best administered via the bolus method (slow push with a syringe) rather than a feeding pump, as the thicker viscosity can cause pump failure or alarm errors. This can also extend feeding times.
Comparison: Homemade BTF vs. Commercial Formula
| Feature | Homemade Blenderized Tube Feeding (BTF) | Commercial Enteral Formula |
|---|---|---|
| Ingredients | Whole, real foods blended into a smooth consistency. | Standardized liquid or powder made of processed ingredients. |
| Consistency | Thicker, potentially requiring additional liquid to flow properly. | Thin and uniform, designed for smooth flow through various tube sizes. |
| Preparation | Requires careful blending, straining (optional but recommended), and sanitary handling. | Ready-to-use liquid or powdered formula mixed with water. |
| Cost | Can be more or less expensive depending on ingredients, but additional equipment may be needed. | Often expensive, but may be covered by insurance. |
| Nutritional Profile | Variable; must be carefully planned by a dietitian to meet specific needs. | Standardized and nutritionally complete, providing a consistent nutrient supply. |
| Gastrointestinal Effects | Often associated with improved tolerance and reduced symptoms like reflux. | Can sometimes cause intolerance, gas, or other GI issues in some patients. |
| Risk of Clogging | Higher risk if not blended smoothly enough or if tube is too small. | Lower risk due to uniform, thin consistency. |
| Feeding Method | Best administered via the bolus method with a syringe due to viscosity. | Can be given via bolus or continuous pump feeding. |
Step-by-Step Guide to Puree Administration
Once your healthcare team has approved a BTF regimen, follow these steps for safe administration via a G tube:
- Preparation: Gather all ingredients and equipment, including a high-speed blender, storage containers, a sieve (optional but recommended), a 60ml syringe with a catheter tip, and warm water for flushing.
- Blend the Food: Using a high-powered blender, combine ingredients with enough liquid (water, broth, milk) to achieve a smooth, lump-free, liquidized consistency. Aim for a texture similar to that of a thin milkshake or double cream.
- Strain (if necessary): To ensure no small particles remain that could cause a clog, pour the blend through a fine-mesh sieve.
- Administer the Feed:
- Wash your hands and position the patient in a sitting or semi-reclined position (at least 45-degree angle).
- Connect the 60ml syringe, filled with the blended food, to the G tube extension set.
- Administer the food slowly using gentle, pulsing pushes on the syringe plunger. Do not force the feed. This process should take 15-20 minutes, similar to a regular mealtime.
- Flush the Tube: After the feed is complete, flush the tube with the prescribed amount of warm water. This is a critical step to prevent formula and food particles from drying and causing a blockage.
- Clean Up: Disconnect the syringe and extension set, closing the G tube port. Wash all equipment thoroughly with warm, soapy water and allow to air dry.
Troubleshooting and Safety
- Dealing with Clogs: If a clog occurs, check for kinks in the tubing and try flushing with warm water using a 'push-pull' method with a 60ml syringe. Do not use excessive force or attempt to clear with objects. If the clog persists, contact your medical team.
- Monitoring Tolerance: Watch for signs of feeding intolerance such as vomiting, bloating, or diarrhea. Adjusting the recipe or feeding schedule may help, but always consult with your dietitian.
- Proper Hygiene: Strict food safety is non-negotiable. Wash hands, surfaces, and utensils thoroughly. Prepare and store blended food according to standard food safety guidelines to minimize contamination risk.
- Emergency Plan: Have a contingency plan in place, including alternative feeding options (like commercial formula) for times when preparing a blended diet isn't possible, such as during travel or a hospital stay.
Conclusion
Yes, you can put puree through a G tube, and for many patients, it offers a beneficial alternative to commercial formulas. Known as blenderized tube feeding (BTF), this approach has been shown to improve gastrointestinal symptoms, increase diet variety, and support emotional well-being. However, its success hinges on careful planning, proper food preparation, and meticulous G-tube care to prevent blockages and foodborne illness. Before starting, it is imperative to consult with a medical team, including a registered dietitian, to ensure the diet is nutritionally complete and safe for the individual's specific needs. With the right guidance and techniques, BTF can be a safe and rewarding way to provide real food nutrition via a G tube.
Additional Resource
For more detailed information and support regarding blenderized tube feeding, consult resources from organizations like the Oley Foundation, which provides guidance for home parenteral and enteral nutrition users: The Oley Foundation.
