Study of the feeding tube optimal diameter for enteral nutrition in a model experiment

Introduction. The question of selecting the optimal diameter of gastrostomic tubes for enteric feeding remains unresolved. The aim of the study is to justify the choice of tube diameter for enteric feeding by studying deposits on the inner wall. Materials and Methods. A model for the introduction of specialized enteric and blender food through a tube at a temperature ranging from 36° to 40 °C has been developed. Polyvinylchloride probes with a length of 110 cm and an outer diameter ranging from 10 to 30 Fr with a step of 2 Fr are used as nutrient tubes. An imitation is performed nourishment 5 times a day for 300 ml for 30 days. After simulation, the probe’s internal clearance will wash 150 ml of water with a temperature of 37 °C, dried. At the beginning and end of the experiment, weighing and measuring the length of the probe was carried out. The results and their discussion. The specialized feed caused a blockage of 10 and 12 Fr probes, which were removed by washing 150 ml of water. There was no significant change in the mass of probes after the enteric feeding, indicating minimal sediments on the inner surface. The blending caused a blockage of probes 10, 12 and 14 Fr in diameter. Probes 10 and 12 Fr in diameter could not be recovered from washing with water. The power deposition on the inner walls of the probes was visually determined. No significant changes in the length of the probes were observed during the experiment. However, the change in the mass of probes after the blender feed is statistically larger than after the specialized one (p<0.001, Mann-Whitney criterion). Conclusion. It is advisable to use gastrostomic tubes with a diameter of 14-18 Fr to feed specialized mixtures. 18-24 Fr diameter tubes should be used when using a blender supply.

gastrostoma, palliative patients, gastrostomic tube diameter, simulated feeding, enteric feeding, blender feeding, dietary deposition, blockage of the feeding tube

1. Strokova T.V., Kamalova A. A., Zavyalova A. N., et al. Principles of nutritional support in children with cerebral palsy. In the collection: Actual problems of abdominal pathology in children. Materials of the XXVIII Congress of Pediatric Gastroenterologists of Russia and CIS countries. 2021. S. pp. 290-335. (In Russian)@@ Строкова Т. В., Камалова А. А., Завьялова А. Н. и соавт. Принципы нутритивной поддержки у детей с детским церебральным параличом. В сборнике: Актуальные проблемы абдоминальной патологии у детей. Материалы ХХVIII Конгресса детских гастроэнтерологов России и стран СНГ. Техническая подготовка к изданию осуществлена д. м. н. С. В. Белмер и к. м. н. Т. В. Гасилина. 2021. С. 290335.

2. Bischoff S.C., Austin P., Boeykens K., et al. ESPEN guideline on home enteral nutrition. Clin Nutr. 2020;39(1):5-22. doi:10.1016/j.clnu.2019.04.022

3. Park S.K., Kim J. Y., Koh S. J., et al.Complications of percutaneous endoscopic and radiologic gastrostomy tube insertion: a KASID (Korean Association for the Study of Intestinal Diseases) study. Surg Endosc. 2019;33(3):750-756. doi:10.1007/s00464-018-6339-1

4. Zavyalova A. N., Gavschuk M. V., Kuznetsova Yu.V., et al. Analysis оf Cases оf Gastrostomia in Children at Different Age Periods. Clinical Nutrition ESPEN. 2021, vol. 46, pp. S733-S734. (in Russ.)

5. Anderson L. Enteral feeding tubes: an overview of nursing care. Br J Nurs. 2019;28(12):748-754. doi:10.12968/bjon.2019.28.12.748

6. Simakhodsky A.S., Leonova I. A., Penkov D. G., et al. Nutrition of a healthy and sick child St. Petersburg, 2021. Volume Part 2 (In Russian)@@ Симаходский А. С., Леонова И. А., Пеньков Д. Г. и соавт. Питание здорового и больного ребенка. Санкт-Петербург, 2021. Том Часть 2

7. Boeykens K., Duysburgh I. Prevention and management of major complications in percutaneous endoscopic gastrostomy. BMJ Open Gastroenterol. 2021;8(1): e000628. doi:10.1136/bmjgast-2021-000628

8. Guha S., Ravi N., Silverstein J. S., et al. In Vitro Performance Testing of Legacy and ENFit Gastrostomy Tube Devices Under Gravity Flow Conditions. JPEN J Parenter Enteral Nutr. 2018;42(8):1334-1341. doi:10.1002/jpen.1159

9. Risselada M., Griffith E., Kapler M,, et al. Evaluation of various gastrojejunostomy tube constructs for enteral support of small animal patients. J Am Vet Med Assoc. 2018;252(10):1239-1246. doi:10.2460/javma.252.10.1239

10. Gostimskii A.V., Gavshchuk M. V., Zav’yalova A.N., et al. Features of nutritional support and care of patients with gastrostomy. Medicine: theory and practice. 2018;2 (3): 3-Zav’yalova A.N., Gostimskii A. V., Lisovskii O. V., et al. Enteral nutrition in palliative medicine in children. Pediatrician. 2017;6 (8):105-113. (In Russian) doi:10.17816/PED86105-113@@ Завьялова А. Н., Гостимский А. В., Лисовский О. В. и соавт. Энтеральное питание в паллиативной медицине у детей. Педиатр. 2017. № 6 (8). С. 105-113.

11. Khubutia M. Sh., Popova T. S., Saltanov A. I. Parenteral and enteral nutrition [Electronic resource]: national guidelines. Moscow. GEOTAR Media Publ., 2015. (In Russian).@@ Парентеральное и энтеральное питание [Электронный ресурс]: национальное руководство. Под ред. М. Ш. Хубутия, Т. С. Поповой, А. И. Салтанова. М.: ГЭОТАРМедиа, 2015.

12. Gavschuk M. V., Gostimsky A. V., Bagaturiya G. O., et al. Import substitution possibilities in palliative medicine. Pediatrician. 2018;9(1):72-76. (In Russian) doi: 10.17816/PED9172-76@@ Гавщук М. В., Гостимский А. В., Багатурия Г. О., и cоавт. Возможности импортозамещения в паллиативной медицине. Педиатр. 2018. № 9(1). С. 72-76.

13. Luft V. M., Lapitsky A. V., Sergeeva A. M. Handbook of Clinical Nutrition. St. Petersburg Scientific Research Institute of Emergency Medicine named after. I. I. Dzhanelidze, Northwest Association of Parenteral and Enteral Nutrition. St. Petersburg. LLC “RA Russian Jeweler” Publ., 2018. 368 p. (In Russian)@@ Луфт В. М., Лапицкий А. В., Сергеева А. М. Справочник по клиническому питанию. Санкт Петербургский научно-исследовательский институт скорой помощи им. И. И. Джанелидзе, Северо-Западная ассоциация парентерального и энтерального питания. - СПб: ООО «РА Русский Ювелир», 2018. - 368 с.

14. Palmer S. J. An overview of enteral feeding in the community. Br J Community Nurs. 2021;26(1):26-29. doi:10.12968/bjcn.2021.26.1.26

15. Chen M. C., Chao H. C., Yeh P. J., et al. Therapeutic Efficacy of Nasoenteric Tube Feeding in Children Needing Enteral Nutrition. Front Pediatr. 2021;9:646395. Published 2021 Mar 18. doi:10.3389/fped.2021.646395

16. Milton D. L., Johnson T. W., Johnson K., et al. Accepted Safe Food-Handling Procedures Minimizes Microbial Contamination of Home-Prepared Blenderized Tube-Feeding. Nutr Clin Pract. 2020;35(3):479-486. doi:10.1002/ncp.10450

17. Lord L. M. Enteral Access Devices: Types, Function, Care, and Challenges. Nutr Clin Pract. 2018;33(1):16-38. doi:10.1002/ncp.10019

18. Ojo O., Keaveney E., Wang X. H., et al. The Effect of Enteral Tube Feeding on Patients’ Health-Related Quality of Life: A Systematic Review. Nutrients. 2019;11(5):1046. Published 2019 May 10. doi:10.3390/nu11051046

19. Hron B., Rosen R. Viscosity of Commercial Food-based Formulas and Home-prepared Blenderized Feeds. J Pediatr Gastroenterol Nutr. 2020;70(6): e124-e128. doi:10.1097/MPG.0000000000002657

20. Skurihin I. M., Tutel’yan V. A. Tables of the chemical composition and calorie content of Russian food products: a Handbook. Moscow. DeLi print Publ., 2008. 276 P. (in Russ.)@@ Скурихин И. М., Тутельян В. А. Таблицы химического состава и калорийности российских продуктов питания: Справочник. М.: ДеЛи принт, 2008. - 276 с.