This part covers the tube type, route, diameter and retention device best suited to blended diet. Where a person or their family is considering blended diet before a tube is placed, tell the team placing it. Retention device and diameter are most easily influenced at that point and are harder to change later.
| What tube manufacturers say. The Enteral Products Safety Group, which represents UK suppliers of enteral feeding devices, accepts in its November 2026 position statement that some devices may be compatible with blended food, on the advice of a healthcare professional. For practice recommendations it refers clinicians to this Toolkit. |
1. Use blended diet with a balloon retained gastrostomy tube or low profile device (button) where there is a choice
Gastrostomy provides a direct route to the stomach and is the tube most commonly used with blended diet, in UK practice and in international cohort studies.
Balloon retained tubes can easily be changed in the community, whereas disc retained tubes require a hospital admission to replace.
A disc retained tube is not a reason to rule blended diet out. Many adults are fed by disc retained tubes for years, often at a wider bore, and blended diet is used successfully with them where there is an agreed plan for how nutrition, fluid and medication would be given if the tube is blocked, and for how the tube would be replaced.
Where gastric feeding using commercial enteral formula is poorly tolerated, blended diet given via the gastrostomy should be considered before changing to jejunal feeding.
2. Assess a request for nasogastric use individually
Where gastrostomy placement is not possible and blended diet could offer benefits, assess case by case.
Be aware that nasogastric tubes are both longer and narrower, delivery pressure and tube integrity have not been measured, and that in the published cohorts the only tube occlusions reported occurred with nasogastric and nasojejunal tubes.
The concern that a tube could split above the epiglottis and lead to aspiration is theoretical, and no case has been reported.
A parent’s account of blended diet via a nasogastric tube is published with the case studies.
3. Treat post-pyloric (jejunal) use as exceptional
Post-pyloric feeding bypasses the stomach, and the jejunum has less storage capacity, so food must be delivered more slowly to avoid dumping and the volume given at any one time is limited.
Bypassing gastric acid also makes food safety more important. It has been done: the scoping review includes a jejunostomy series, and dietitians report outcomes similar to gastrostomy feeding, though with variable confidence and little guidance to work from.
Treat it as exceptional rather than routine, and agree it with the multidisciplinary team.
Where a gastro-jejunal tube is used, administer blends through the gastric port, noting that the gastric lumen is narrower and the blend may need to be thinner.
4. Use a 12Fr diameter tube or above where there is a choice
Most people using blended diet in the UK have a 12Fr tube, but narrower tubes can be used, and size alone should not preclude it.
There is no need to dilate an existing stoma to fit a larger tube. A thinner blend may be required, though adding liquid can reduce the nutrient density delivered.
Sieve only when the blend is not smooth or contains seeds or skins, not as a matter of routine (Part 5).
Blending for at least two minutes in a high-powered blender may make sieving unnecessary.
5. Use blended diet with a mature stoma
A blocked tube in an unformed tract cannot be changed at home, so judge maturity against the first planned device change rather than elapsed time alone.
Practice reported at the roundtables ranges from around six weeks to six months, and services should agree a local position, which may be shortened after discussion with the clinician who placed the tube.
Agree with the centre that placed the tube who will replace it and how quickly, and record it.
This matters most for gastro-jejunal and other complex devices, where replacement may not be available locally.
| Tube blockage is uncommon, but it can occur. It is more commonly caused by medication than by food blends. Every tube-fed person or their carers should be taught to check tube and site integrity, to flush to maintain patency, and to have an agreed plan for what to do if the tube blocks. This matters most where the tube is the only route for food, fluid and medication. |