Blended diet requires little in the way of additional ancillaries, which are provided by the NHS. This part covers what to provide and how it should be cleaned.
The ancillaries used for blended diet are those already used in bolus home enteral tube feeding with a commercial enteral formula: enteral syringes, typically 60ml and often several per day, compatible extension sets for gastrostomy buttons, containers for storing blends and giving sets if a pump is used.
1. Provide ancillaries as per local bolus feeding policy
The same number of ancillaries is generally provided to people on blended diet as to the wider home enterally fed population, though individual assessment may show otherwise (point 3), and the number supplied varies regionally.
2. Reuse ancillaries with a standardised cleaning procedure
Syringes and containers should be washed in warm soapy water, rinsed and left to air dry. The cleaning method, drying and inspection determine whether reuse is safe. Equipment that is damaged or degraded should be replaced.
Manufacturers’ own cleaning instructions vary and can be followed where provided. Some provide guidance on the number of uses.
Only food grade storage containers designed for repeated use should be used to store blends, and the manufacturer’s guidance followed on whether a container is suitable for the microwave, freezer or dishwashing.
3. Assess the need for additional or O-ring syringes individually
Professionals note that the numbers on the enteral syringe can wear off with repeated use, although this is not necessarily a problem where the syringe is filled to its full capacity each time.
O-ring syringes, which have a thin rubber sealing ring on the plunger, were reported at the roundtables to help where the slow plunge method is used. Lubricating the rubber ring with a cooking oil is reported to extend the life of the syringe and reduce carer hand strain.
Depending on the food ingredients chosen, blended diet may result in staining and increased wear on plastics.
4. Use either a straight or right-angled extension set
Either a straight bolus or right-angled extension set can be used, the choice is one of personal preference.
Some people prefer a straight set for ease of administration. Others prefer a right-angled set, since it is then the narrowest part of the feeding system, so a blend that passes through it should pass easily through the button without blocking it.
5. Giving sets are required for people using pumps
Enteral feeding pumps designed for use with blended foods are now available in the UK market (Part 9). Dietitians who have supported people to access these pumps have needed to access personal health budgets to supply giving sets outside their normal enteral feeding contract.