Enteral Feeding Pump ASPEN Practice Recommendations

 

Several years ago, I remember hearing discussions about having neonatal enteral-only feeding pumps. It was one of those conversations that was in the background of another conversation, and really did not hold my attention.

Fast forward a couple of years later, and this recommendation was coming through loud and clear from several regulatory associations. Those included The Joint Commission, Academy of Nutrition and Dietetics, and American Society for Parenteral and Enteral Nutrition (ASPEN). In an effort to be compliant with these recommendations and implement best practices, the hospital where I worked moved forward with enteral-only syringe pumps.

Today the emphasis is not only on having an enteral-only feeding pump. Now it is equally as important to evaluate the safety and accuracy of the enteral feeding pump.

Enteral feeding pump accuracy

Not all feeding pumps are equal with the accuracy in which they deliver the preset volume. Feeding pump inaccuracy occurs when pumps deliver rates and volumes under and over the amount prescribed. Accuracy is critically important (especially in the neonatal and pediatric populations) because small variances in volume can have a significant impact on delivering adequate nutrition. The most recent comprehensive publication to provide recommendations based on available evidence for safe and accurate delivery of enteral feeds is the ASPEN Safe Practices for Enteral Nutrition Therapy.1

Here are the key enteral feeding practice recommendations they addressed for safe and accurate administration of enteral feeds on a pump:

• Zero the volume delivery amount on the feeding pump at the beginning of the feed, then check full amount was delivered; this serves as a double-check for accuracy
• Compare time feeding started with the completion time of infusion to measure if feeding delivery is no more or less than time programmed; this double-checks feed delivered within time period
• Consider a volume-based ordering system compared to rate-based delivery
• Follow manufacturer recommendations for use; for example, not all pumps are designed to rotate
• Ensure regular biomedical engineering department testing according to manufacturer recommendations
• Monitor age, service, condition, and depreciation, as these factors influence the accuracy of the pump1,2

Enteral feeding pump features

There are features to consider when purchasing neonatal enteral feeding pumps that will not only accommodate the above recommendations, but also provide further nursing and patient value:

• The ability to zero out the volume delivered for each feeding, or the ability to track the volume over a time period (i.e. 12 to 24 hours)
• Options for mode of delivery to include both volume-based and rate-based delivery
• Notification of incorrect key presses, and the ability to set “rate alert”
• Will display the rate of infusion, volume delivered, and time remaining until complete
• Alarms designed to indicate interruption, volume delivered, and idle or inactivity – pump may appear to be infusing and it is not
• Ability to track total volume infused for one feeding, or volume infused over a period of time – this serves as a double-check for accuracy
• User friendly, portable, and accurate
• Electronic connectivity to electronic medical record (EMR or EHR) for documentation of enteral volume infused

Electronic connectivity of the enteral feeding pump to an EMR is a feature that most manufacturers are working on or have available. Enteral feeding pumps are the last on this frontier to move forward with having this technology available.

When considering updating or purchasing neonatal enteral feeding pumps for your NICU, take a moment to review the updated ASPEN practice recommendations. They are available to help with guiding many aspects of enteral nutrition, including safe and accurate pump feeding.

References:

1. Boullata, JI., Carrera AL., Harvey, L., et al. ASPEN safe practices for enteral nutrition therapy. JPEN J Parenter Enteral Nutr. 2017; 41(1):15-103.

2. Spronk PE., Rommes, JH, Kuiper MA. Structural underfeeding due to inaccurate feeding pumps? JPEN J Parenter Enteral Nutr. 2007;31(2):154.