Enteral feeding

1. USEFULNESS OF INFUSION
PUMPS IN FEEDING THE
PATIENTS
Mrs. Grace Lydia, Asst professor
Omayal Achi College of Nursing, chennai

3. Highlights of this session
1. Introduction
2. Definition
3. Key driving forces
4. Key restrictions
5. Determinants
6. Types
7. Advancements
8. Pioneers
9. Factors affecting
pump selection
10. Uses
11. IV Pumps today
12. Purposes of using
smart pumps
13. Beyond the walls
14. Barriers

4. 1. INTRODUCTION
• Enteral tube feeding - in place for 3,500 years.
• Originally used by the ancient Greeks and
Egyptians
• Early aims - alleviate various bowel disorders
through infusion of nutrient solutions into the
rectum.
• 16th century
– hollow tubes with attached animal bladders enabled
esophageal feeding
– the first recorded provision of feeding into the upper
gastrointestinal tract.

5. 2. DEFINITION
• Infusion pumps - Provides nutrition to patients
who are unable to ingest food, either because of
recent surgery or because of the inability of
various digestive organs to function properly.
• An enteral pump is a device used to deliver
fluids into a patient’s body – GI tract in a
controlled manner.
• Although non-enteral infusion pumps can be
used -not considered accurate

6. 3. KEY DRIVING FORCES
Technology
Aging
population
Increased
chronic
conditions
Demand –
active life
style
Growing
affluence in
emerging
economies

7. 4. KEY RESTRICTIONS
Regulatory mandates
Operational cost
Maintenance cost
Competition – low tech and ambulatory

8. 5. DETERMINANTS
DETERMINANTS OF USE
– Accuracy
– Safety
– Consistency of the delivered formula

9. 6. TYPES OF INFUSION PUMP
Large volume pumps
• Can pump nutrients large enough
• Use some form of peristaltic pump.
• Computer controlled rollers compressing a silicone
rubber tube is used
Small volume pump
• Used – hormones, medicines
• use a computer -controlled motor turning a screw that
pushes the plunger on a syringe

10. 6. TYPES – BASED ON
OPERATION
Elastometric pump
• Fluid is held in stretchable balloon reservoir
• pressure from the elastic walls of the balloon drives fluid delivery.
Peristaltic pump
• Set of rollers pinches down on a length of flexible tubing – pushing
fluid forward.
Multichannel pump
• Fluids can be delivered from multiple reservoirs at multiple rates
Smart pump
• Equipped with safety features – user alarms – activates when
parameters are set outside limit

13. Basic Pumps
(flow/time)
Pump with drug
library
Smart pump
(concentration limits)
Smart, wireless pumps
with Server
Pump Interoperability
7. INFUSION PUMP
ADVANCEMENTS
Capability
EMR
70-80’s 2000’s 2010’s1990’s

14. 8. PIONEERS
• Leaders include
– Abbott, Baxter
– Carefusion, Hospira
– Medtronic, Roche
– Medtronic, J&J (Animas, Depuy)
– Fresenius, Moog,
– Smiths Medical and B. Braun.
• Innovators include
– I- Flow, Insulet and several other insulin patch
pump makers

15. Enteral Feeding Pumps

20. • Competitor Comparison
•
MODEL WEIGHT ACCURACY BATTERY
LIFE
Kangaroo
Joey
770g +/- 7% +/- 7% 18hr at
125ml/hr
Infinity 411g +/- 5% 24hr at
125ml/hr
Adept 270g +/- 5 % 4800hr at
125ml/hr

21. 9. FACTORS IN PUMP
SELECTION
• Simple to use
(intuitive)
• Alarm system
• Lightweight
• Long battery life
• Portable
• Volume infused
indicator
• Dose function
• Flow rate accurate to
within 10%
• Approved for age
range in which it will
be used
• Permanently attached
cord

22. 10. USES
Precise delivery
Even rate
Maximized patient tolerance
Reduced likelihood of tube blockage
Easy to deliver high fibre energy dense
formulae

23. Today, intelligent infusion pumps:
• Networked
• Management software - promote safe administration
• Send and receive data over the network, stores data in
servers
• Collect and transfer data for reports - used for analysis -
continuous quality improvement (CQI) initiatives.
• Now considered “computers” at the bedside.
11. IV PUMPS TODAY

24. 12. PURPOSES OF USING
SMART PUMPS
Safe
Dose specific
Less error
Changes role – critical thinker
New level of detail in CQI mining

25. • Gives snap shot of safety
trends, events prevented
and errors
• Measures effectiveness
against medication errors
and patient safety
• Increased efficiency
• Cost effectiveness
• Real time data
• Better planning for
supplies
• Less incidents to
investigate and resolve
• Bye – manual
charting
• Auto documentation
• Less – error,
incidental report and
disciplinary actions
• More time at bedside
• Positive outcome
• Error free/less
• Less hospital stay
• Confidence with
hospital facility
• Less noise with
alarms
PATIENT NURSES
HOSPITAL
EXECUTIVE
S
PHARMACI
ST

26. Clinical Reports Inform Clinical
Decisions
• Drug Program Compliance
Reports
• Safety Event Reports
• Drug Program Utilization
Reports
• Device Event Reports

27. • The big challenge is put in front of vendors
and IT professionals to make wireless
integration work beyond the hospital walls
• As in Home Health care scenarios where
pumps may malfunction and no one knows
about it.
13. BEYOND THE WALLS

28. 14. BARRIERS
• Pumps can
restrict mobility
• Other health
implications
• Dumping
syndrome
• Decanting in to
Syringe – Risk
for bacteria
• Too heavy
• Frequent false
alarms –
Occlusion
• Short battery
lives
• Syringes have
to be held up for
pressure head
• Syringe feeding
takes away my
dignity in social
setting
PATIENTS CLINICIANS

29. Reflection ….
1. Introduction
2. Definition
3. Key driving forces
4. Key restrictions
5. Determinants
6. Types
7. Advancements
8. Pioneers
9. Factors affecting
pump selection
10. Uses
11. IV Pumps today
12. Purposes of
using smart pumps
13. Beyond the walls
14. Barriers

30. • Less error and hospital stay
• Better satisfaction and outcome.

31. REFERNCES
• Gorman RC, Nance ML, Morris JB. Enteral feeding techniques. In: Torosian
MH, editor.Nutrition for the Hospitalized Patient: Basic Science and
Principles of Practice. New York, NY: Marcel Dekker Inc; 1995. pp. 329–
351.
• Barron J, Prendergast JJ, Jocz MW. Food pump; new approach to tube
feeding. J Am Med Assoc. 1956;161(7):621–622.(pubmed)
• Viall C. Enteral feeding technology. Nursing. 1994;24(8):32J–
32K. (PubMed)
• 22. Jones SA, Guenter P. Automatic flush feeding
pumps. Nursing. 1997;27(2):56–58.(PubMed)
• ASPEN. The science and practice of nutrition support. A case-based core
curriculum. 2001; 148
• ADA EAL Evidence-Based Guidelines, accessed 1/09