Comparison of enteral delivery systems on the nutritional status of nursing home residents

Abstract

Emphasis on cost containment in nursing homes by Medicare requires justification for enteral feeding pumps. There are two methods of formula delivery via a pump, the Closed System (CS) and the Open System (OS). The CS is a prefilled container of formula accessed by an administration set or “spike set”. The CS formula is good for 24–48 hours once accessed, depending on the manufacturer's guidelines. With the OS cans of formula are poured into a pump container which is good up to eight hours in most cases, depending on manufacturer's guidelines. The cost of a CS is now comparative to that of a traditional OS in some markets. In addition, substitution of a closed continuous pump for the OS reduces nursing time and decreases the probability of errors. Although the effect of various methods of enteral delivery on residents complications has been evaluated, the effect on nutritional outcome has not been researched. The purpose of this pilot study was to compare the effects of the CS, OS and Gravity Delivery (GD) enteral nutrition systems on the nutritional status of nursing home residents. Medical records from 30 tube-feeding nursing home residents were retrospectively reviewed for weight, weight change and serum albumin level. Criteria for inclusion into the study were 1) that the residents were maintained on tube feedings solely, 2) lab data and weight were available upon admission and at six months post admission, and 3) absence of chronic diseases (such as renal) which might affect nutritional status. The study population was small due to ‘he unavailability of lab values at six-months post admission. Seven patients were overweight and therefore not included in the weight loss section of this study. On the CS all seven of the normal and underweight patients maintained their weight or pained at 78% to 121% of their estimated caloric requirement. On the OS three of seven (43%) of the normal or underweight patients lost weight at 112% to 137% of caloric requirement; four of nine (44 % of the normal or underweight patients on GD lost weight at 101% to 128% of estimated caloric requirement. The albumin dropped .4 gm./dl. to .9 gm./dl. an four patients (three on CS and one on GD). These four patients had not lost weight. The significant drop in albumin for patients in this population who did not lose weight indicates a need for semi-annual lab work. The OS needs close monitoring for weight loss (possibly related to nursing time needed to maintain the system). The GD system also needs monitoring to prevent weight loss (possibly related to measuring errors). As the price of the CS continues to decline, facilities may wish to switch all pump patients on to the Closed System, obtain semi-annual lab values, and mentor patients on Gravity Delivery systems closely for signs of unplanned weight lose.