School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
Hertfordshire Independent Living Service, Letchworth, UK.
J Hum Nutr Diet. 2019 Oct;32(5):667-675. doi: 10.1111/jhn.12685. Epub 2019 Jul 3.
Concerns associated with blended enteral feeds include the risk of blocked tubes and microbial contamination, although the available evidence is limited. The present laboratory-based investigation aimed to examine these risks in a blended feed providing a nutritionally adequate intake for a hypothetical patient.
A one-blended feed recipe was made using three different methods (professional, jug and stick blenders) and three storage procedures. Feed samples were syringed via 10-, 12- and 14-French (Fr) enteral feeding tubes and both blockages and the time taken were recorded. Feed samples were diluted, plated on agars, incubated and bacterial colony-forming units (CFU) counted. After storage at -80 °C, identification was undertaken using 16S rRNA polymerase chain reaction sequencing.
Two blockages occurred during 27 administrations of feed made using a professional blender, although they were resolved with a water flush. No blockages occurred with the 14-Fr tube and administration was quicker with wider tubes (P < 0.00001). There was no significant difference between the total bacterial CFU of feeds prepared using different methods (P = 0.771) or stored differently. The genus of bacteria identified included Enterococcus, Bacillus, lactose-fermenting Enterobacteriaceae, Pseudomonas and Staphylococcus. Pathogens, such as Clostridium spp., Salmonella spp. and Vibrio spp., were not identified by phenotypic tests used. Sequencing identified Escherichia coli, Shigella spp., Streptococcus lutetiensis and Staphylococcus epidermidis.
The present study found no risk of tube blockages when one blended feed recipe made using three methods was delivered via a 14-Fr tube. There is concern about bacterial contamination, although this was not influenced by the methods of preparation or storage used in the present study.
混合肠内喂养相关的问题包括管腔堵塞和微生物污染的风险，尽管现有证据有限。本实验室研究旨在检查为假设患者提供充足营养摄入的混合喂养中出现这些风险的可能性。
使用三种不同方法（专业搅拌机、搅拌棒和搅拌杯）和三种储存程序制备一种混合配方。通过 10、12 和 14Fr 肠内喂养管将饲料样本抽吸，并记录堵塞情况和所需时间。将饲料样本稀释、平板接种、孵育并计数细菌菌落形成单位（CFU）。储存于-80°C 后，使用 16S rRNA 聚合酶链反应测序进行鉴定。
使用专业搅拌机制备的饲料在 27 次给药中发生了两次堵塞，但用水冲洗后得以解决。14Fr 管未发生堵塞，且较宽的管腔给药速度更快（P<0.00001）。不同方法制备（P=0.771）或不同储存方法的饲料总细菌 CFU 无显著差异。鉴定出的细菌包括肠球菌、芽孢杆菌、乳糖发酵肠杆菌科、假单胞菌和葡萄球菌。表型测试未鉴定出梭菌属、沙门氏菌属和弧菌属等病原体。测序鉴定出大肠杆菌、志贺氏菌属、路邓葡萄球菌和表皮葡萄球菌。
本研究发现，使用三种方法制备的一种混合喂养配方通过 14Fr 管给药时，不存在管腔堵塞的风险。虽然本研究中使用的制备和储存方法未对细菌污染产生影响，但存在细菌污染的担忧。
