The use and experience of registered dietitians with blended diets given via a gastrostomy in the UK

Abstract

OC2 THE USE AND EXPERIENCE OF REGISTERED DIETITIANS WITH BLENDED DIETS GIVEN VIA A GASTROSTOMY IN THE UK L.A. Cantwell, B. Ellahi. Faculty of Health and Social Care, University of Chester, CH1 4BJ, UK Blended diets (BD) describes blending/liquidising household food to a liquid consistency to allow administration via an enteral feeding tube to provide nutrition. Current standard practice uses a commercially prepared formula, the advantages being; sterility, less labour intensive, known nutritional composition and reduced administration error [1]. Despite these advan- tages there is an emerging culture, most notably observed amongst the paediatric population to provide “real food” via a gastrostomy tube. How- ever, there is a paucity of evidence to either support or refute this practice. Studies undertaken in hospital settings [2e5] report a higher level of mi- crobial contamination and uncertainty surrounding the nutritional content of BD. Conversely, some small case reviews have demonstrated potential benefits of BD, mostly notably in managing GI disturbance [6,7]. In the UK the British Dietetic Association (BDA) does not recommend the use of BD [8]. However, through following social media and discussion with colleagues it's likely that BD is being used in the UK. This study aimed to identify the use and experience of registered dietitians working in enteral nutrition with BD. An online survey circulated through BDA specialist groups and branches gathered 188 responses. Data was analysed using descriptive statistics and Chi Squared tests using Yates Continuity Correc- tion and Cramer's V Correlation Co-efficient to infer significant associations. Nearly a quarter of respondents (n1⁄445; 23.9%) had patients using BD. There was a significant association (P<0.05) between area of practice, type of patient and use of BD (75% community versus 25% hospital and 64% paediatrics, 9% adults and 27.4% both). The most commonly selected reason for using BD was request from carer/patient (93.3%) followed by management of reflux (53.3%) and intolerances to formula (40%). Dietitians using BD observed positive improvements in reflux and bowels. Concerns regarding nutritional adequacy were reported by 53.3% of dietitians (significantly or somewhat) compared to 20% whom felt unconcerned (significantly or somewhat) while the remaining respondents (26.7%) remained neutral. Nearly 78% and 69% reported no greater occurrences of tube blockages and stoma infections respectively, amongst those using BD compared to patients receiving commercial formula. When asked to rate their patient/carer experiences of BD there were no negative responses and the majority were positive experiences (very good 60%, excellent 26.7%). Amongst those not using BD the most frequently selected reasons were, it wasn't requested by patient/carer (76%), risk of tube blockages (51.7%), unknown nutritional content (42.6%) and infection risk (40.6%). Over 90% of respondent stated that they would like further infor- mation regarding BD most notably around nutritional adequacy, risk of blockages and patient experience. BD is being used in the UK. It appears to result in a positive patient experience and can be effective in managing GI disturbances. Despite concerns the use of BD does not appear to have resulted in significant complications. Finally, it's evident through the significant number of re- spondents requesting further information that dietitians potentially feel that there is a lack of evidence around the implementation of BD in the UK. References [1] Campbell S. An anthology of advances in enteral tube feeding formu- lations. Nutr Clin Prac 2006;21:411e15. [2] Borghi R, Dutra Araujo T, Airoldi Vieira R I, et al. ILSI Task Force on enteral nutrition; estimated composition and costs of blenderized diets. Nutr Hosp. 2013;28:2033e8. [3] Barkhidarian B, Seyedhamzeh S, Mousavi N, et al. Nutritional and physical qualities of blenderised enteral diets. Clin Nutr Suppl 2011;6:92e3. [4] Sullivan M, Sorreda-Esguerra P, Platon B, et al. Nutritional analysis of blenderized enteral diets in the Philippines. Asia Pac J Clin Nutr 2004;4:385e91. [5] Jalali M, Sabzghabaee A, Badri S, et al. Bacterial contamination of hos- pital-prepared enteral tube feeding formulas in Isfahan, Iran. J Res Med Sci 2009;14:149e56. [6] Pentiuk S, O'Flaherty T, Santoro K, et al. Pureed by gastrostomy tube diet improves gagging and retching in children with fundoplication. JPEN J Parenter Enteral Nutr 2001;35:375e9. [7] O'Flaherty T. Use of a Pureed by Gastrostomy Tube (PBGT) diet to promote oral intake: review and case study. Support Line 2015;37:21e3. [8] Policy Statement. Use of liquidised food with enteral feeding tubes. British Dietetic Association; 2013. [Accessed June 12, 2016, at https://www. bda.uk.com/improvinghealth/healthprofessionals/policystatement_ liquidisedfood].