Why Height Still Matters for Pump Feeding
While the primary pressure for delivering formula in a pump feeding system is generated by the pump itself, the bag's placement is not irrelevant. Maintaining a consistent, correct height ensures that formula flows smoothly into the pump, preventing air bubbles, occlusion alarms, and inaccurate feeding rates. The pump's internal mechanism relies on a steady, even flow from the bag to function optimally. Failure to follow the manufacturer's hanging guidelines, which typically recommend positioning the bag just above the pump's door, can compromise the system's performance.
The Difference Between Pump and Gravity Feed
For gravity-based enteral feeding, the height of the bag is the sole determinant of flow rate. A higher bag increases the pull of gravity and delivers formula faster, while a lower bag slows the process. Users must manually adjust the roller clamp and bag height to manage the flow. In contrast, an enteral feeding pump delivers formula at a programmed, controlled rate, regardless of minor fluctuations in bag height. The role of bag height with a pump is to provide a consistent, reliable feed into the pump's mechanism, not to control the flow rate directly.
Best Practices for Pump Feeding Setup
- Read the manual: Always refer to your specific feeding pump's instruction manual. Different models may have slightly different requirements for bag placement. The manufacturer's instructions are the most reliable source for your equipment.
- Hang it right: A common manufacturer recommendation, such as for the Kangaroo™ ePump, is to hang the bag so that its bottom is at least 18 inches above the top of the pump. Other pumps, like the EnteraLite Infinity, suggest simply hanging the bag at or above the level of the pump door.
- Prime the tubing: Before connecting to the feeding tube, make sure to prime the tubing to remove all air. The presence of air can trigger alarms and interrupt the feeding process.
- Check the connection: Securely connect the feeding set tubing to the pump and the feeding tube. Loose connections can lead to leaks and inaccurate delivery.
- Keep it clean: Always practice good hygiene by washing your hands and cleaning the top of the formula container before pouring. Regularly rinse the feeding bag as directed by your healthcare provider to prevent contamination.
Troubleshooting Common Pump Issues
Even with proper setup, issues can arise. Here are some solutions to typical problems:
- Occlusion or 'No Flow' alarms: Check for kinks in the tubing, make sure the patient isn't lying on the tube, and ensure the pump's door is securely latched over the tubing. With certain pumps, the occlusion detection can be sensitive and may require ensuring the bag is hung correctly.
- Air in the tubing alarms: This can be caused by improper priming or by the bag running empty. If the formula is blenderized, let it sit for a few minutes before pouring to allow air to escape. Re-prime the line if needed.
- Inconsistent flow: While rare with a pump, if you notice the flow is not steady, double-check that the bag is hung correctly and that the tubing is properly threaded through the pump's mechanism. Also, verify that the formula's viscosity is appropriate for the system.
| Feature | Pump Feeding | Gravity Feeding |
|---|---|---|
| Hanging Height | Bag is hung just above the pump door, per manufacturer instructions. Height is not used to control flow rate. | Bag is hung at a specific height (e.g., 2-3 feet) to control flow rate via gravity. |
| Flow Control | Controlled mechanically by the pump's programmed settings. | Controlled manually by adjusting a roller clamp or bag height. |
| Consistency | Highly consistent and precise delivery, even over long periods. | Can be inconsistent; flow rate may change as the bag empties. |
| Monitoring | Less manual monitoring required; pump alarms for issues. | Requires frequent manual monitoring to adjust flow. |
| Cost | Devices and supplies are generally more expensive due to the electronic pump component. | Simpler and less expensive equipment. |
| Best for... | Continuous feeds or those needing tightly controlled rates. | Intermittent or bolus feeds, depending on patient tolerance. |
Conclusion
For enteral feeding with a pump, the exact height of the feeding bag is not a variable for controlling the rate of flow, which is instead managed by the pump's internal mechanics. However, it is essential to hang the bag according to the manufacturer's specific instructions, typically just above the pump door, to ensure consistent formula delivery and prevent operational issues like alarms. This practice, combined with proper hygiene and priming, leads to a reliable and accurate feeding experience. Always consult with a healthcare provider for personalized instructions and to address any concerns regarding your specific pump and feeding plan.(https://www.mskcc.org/cancer-care/patient-education/tube-feeding-pump)
