30. Can Enteral Feeding Patients, Caregivers and Novices Easily Self-train on a Novel Elastomeric Enteral Feeding System?

Background: Living with long-term home enteral (EN) nutrition can be very challenging for patients and caregivers (1). Simplifying EN feeding by providing ambulatory systems that fit lifestyle needs may help reduce EN-associated burdens on patients’ lives (2). Training new EN patients on EN feeding systems often occurs during hospitalization or after discharge depending on available resources (3). This training importantly allows confirmation of competence in use of the system. Self-training on EN feeding system, if feasible for patients and caregivers, could reduce training resource needs. A novel EN feeding system, with the goal of enhanced mobility and reduced burdens, could provide an alternative to home EN patients, filling a gap between simple bolus/gravity systems and more complex pump systems (4). After familarisation training by healthcare professional (HCP), the intended population can easily use this novel System (5).

Purpose: This simulated use study evaluated if EN patients, caregivers and novices could easily self-train on and use a novel elastomeric enteral feeding System, using only instructional materials, with no HCP training or assistance.

Methods: Mobility+ TM is an FDA-cleared elastomeric EN feeding System for patients aged 2 years and older with gastrostomy or jejunostomy feeding tube. The System consists of a lightweight feeding pouch which is the reservoir for up to 500mL of commercial EN formula; a filling-set (used alongside a syringe to fill pouch); and a tubing set to deliver EN formula to a feeding tube or extension set, called a giving-set.
System is supplied with one of 4 available giving-set tubing varieties (each of different length). Each variety has a different flow rate capability allowing for options to deliver EN formula at rates suitable for continuous, cyclical, intermittent and bolus feedings (4). The System works mechanically without need for gravity or electricity. It is wearable, for single-patient use over a 24-hour period in home care settings, and is disposable.

The study had 25 participants; 10 were patients or caregivers familiar with EN and 15 were novices with no prior experience with EN.
Participants were provided with the System, a 60ml ENFit syringe, EN formula, an instructional booklet and matching instructional video. They were asked to complete tasks involved in:
• Filling System with Formula
• Simulating Use (connecting System to an extension set and delivering formula into a cup)
• Wearing, Disconnecting, and Flushing the System
A Flow Rate Guide resource was also provided to participants, which guides on which giving-set tubing to choose. Participants were asked to choose an appropriate giving-set to suit hypothetical EN formula flow rate needs.

Results: With no training or assistance from a HCP, all 25 participants could use the instructional booklet and video to self-train, allowing them to successfully fill; simulate use; flush; and safely wear the System while moving.
Furthermore, participants could successfully use the Flow Rate Guide to choose an appropriate giving-set to suit hypothetical EN formula flow rate needs.

Some novices (n=5) did not coil excess giving-set as instructions directed, and others (1 novice, 1 caregiver) could not disconnect the giving-set from the extension set due to accidental over-tightening. Although these did not cause safety issues in the study, the instructional materials were updated to more clearly guide on wearing and disconnecting the System. All participants felt they would get more familiar with the use of the novel System over time, with the instructional materials as an aid.

Discussion: Patients, caregivers and individuals with no experience in EN can successfully self-train on how to fill, use and wear a novel elastomeric EN feeding System. The instructional materials are therefore easy to follow, allowing for safe use of this novel System, a positive for patients who would benefit from a light, portable EN feeding system that allows for discretion during feeding, to support their quality of life.
Hospitals and home infusion providers working with EN patients could benefit from a sparing of HCP time, and reduction in training resources and costs.

This easy-to-use EN feeding System may further improve efficiencies in EN formula delivery operations, particularly for pump users, as it is maintenance-free. As it operates without electricity, this also makes it a promising alternative for pumps during natural disasters and power outages. Future studies can build on this research by evaluating mobility, psychological and social well-being, quality of life, and clinical outcomes, on clinical use of this System in intended population.

Conclusions: The study showed the System is usable and instructional materials allow for self-training. This novel easy-to-use System may benefit EN patients, caregivers, HCPs and home infusion providers.