The Effects of Glucose Therapy Agents—Apple Juice, Orange Juice, and Cola—on Enteral Tube Flow and Patency

Publication: Canadian Journal of Dietetic Practice and Research
26 February 2016

Abstract

To develop evidence-based hypoglycemia treatment protocols in patients receiving total enteral nutrition, this study determined the effect on enteral tube flow of glucose therapy agents: apple juice, orange juice, and cola, and it also examined the effects of tube type and feed type with these glucose therapy agents. For this study, 12 gastrostomy tubes (6 polyethylene and 6 silicone) were set at 50 mL/h. Each feeding set was filled with Isosource HN with fibre or Novasource Renal. Each tube was irrigated with 1 glucose therapy agent, providing approximately 20 g of carbohydrate every 4 h. Flow-rate measurements were collected at 2 h intervals. The results showed that the glucose therapy agent choice affected flow rates: apple juice and cola had higher average flow rates than orange juice (P = 0.01). A significant difference was found between tube type and enteral formula: polyethylene tubes had higher average flow rates than silicone tubes (P < 0.0001), and Isosource HN with fibre had higher flow rates than Novasource Renal (P = 0.01). We concluded that apple juice and cola have less tube clogging potential than orange juice, and thus may be considered as primary treatment options for hypoglycemia in enterally fed patients. Polyethylene tubes and Isosource HN with fibre were less likely to clog than silicone tubes and Novasource Renal.

Résumé

Afin d’élaborer des protocoles thérapeutiques fondés sur des données probantes pour l’hypoglycémie chez les patients alimentés par voie entérale seulement, cette étude a examiné l’effet sur le débit dans la sonde entérale des agents régulateurs de la glycémie suivants : le jus de pomme, le jus d’orange et le cola. Elle a aussi examiné les effets du type de sonde et du type d’alimentation utilisés avec ces agents régulateurs de la glycémie. Dans le cadre de cette étude, 12 sondes de gastrostomie (6 en polyéthylène et 6 en silicone) ont été installées à un débit de 50 ml/h. Chaque sac d’alimentation a été rempli d’Isosource HN Fibre ou de Novasource Rénal. Chaque sonde a été irriguée avec 1 agent régulateur de la glycémie, fournissant environ 20 g de glucides toutes les 4 heures. Le débit a été mesuré à des intervalles de 2 heures. Les résultats ont montré que le choix de l’agent régulateur de la glycémie influençait le débit : le jus de pomme et le cola avaient des débits moyens plus élevés que le jus d’orange (P = 0,01). On a observé une différence significative en fonction du type de sonde et de la formule entérale utilisés : les sondes de polyéthylène avaient des débits moyens plus élevés que les sondes de silicone (P < 0,0001), et l’Isosource HN Fibre était associé à des débits plus élevés que le Novasource Rénal (P = 0,01). Nous avons conclu que le jus de pomme et le cola sont moins susceptibles de bloquer la sonde que le jus d’orange, et peuvent ainsi être envisagés comme options de traitement principal pour l’hypoglycémie chez les patients alimentés par voie entérale. Les sondes de polyéthylène et l’Isosource HN Fibre étaient moins susceptibles de causer un blocage que les sondes de silicone et le Novasource Rénal.

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References

1
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2013;37(suppl 1):S1–212.
2
Fischer KF, Lees JA, and Newman JH Hypoglycemia in hospitalized patients: cause and outcomes N Engl J Med. 1986 315 1245 -50
3
Joint British Diabetes Society Inpatient Care Group. The hospital management of hypoglycaemia in adults with diabetes mellitus; 2013 [cited 2015 Mar 2]. Available from: http://www.diabetes.org.uk/Documents/About%20Us/Our%20views/Care%20recs/JBDS%20hypoglycaemia%20position%20(2013).pdf.
4
Rucart PA, Boyer-Grand A, Sautou-Miranda V, Bouteloup C, and Chopineau J Influence of unclogging agents on the surface state of enteral feeding tubes JPEN J Paretner Enteral Nutr. 2011 35 2 255 -63
5
Metheny N, Eisenberg P, and McSweeney M Effect of feeding tube properties and three irrigants on clogging rates Nurs Res. 1988 37 165 -9
6
Wilson M and Haynes-Johnson V Cranberry juice or water? A comparison of feeding-tube irrigants Nutr Support Serv. 1987 7 23 -4
7
Nestle Nutrition. HealthCare Nutrition Product Guide; 2010/2011 [cited 2011 Jun 13].
8
Balkany TJ, Jafek BW, and Wong ML Complications of feeding esophagototmy Arch Otolaryngol. 1980 106 122 -3
9
Pichard C, Kyle UG, Morabia A, Perrier A, Vermeulen B, and Unger P Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay Am J Clin Nutr. 2004 79 613 -8

Supplementary Material

Supplementary Figure (cjdpr-2015-049suppl.pdf)

Information & Authors

Information

Published In

cover image Canadian Journal of Dietetic Practice and Research
Canadian Journal of Dietetic Practice and Research
Volume 77Number 2June 2016
Pages: 93 - 97

History

Version of record online: 26 February 2016

Authors

Affiliations

North York General Hospital Seniors’ Health Centre, North York, ON
Department of Endocrinology, Sunnybrook Health Sciences Centre, Toronto, ON

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References

References

1
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2013;37(suppl 1):S1–212.
2
Fischer KF, Lees JA, and Newman JH Hypoglycemia in hospitalized patients: cause and outcomes N Engl J Med. 1986 315 1245 -50
3
Joint British Diabetes Society Inpatient Care Group. The hospital management of hypoglycaemia in adults with diabetes mellitus; 2013 [cited 2015 Mar 2]. Available from: http://www.diabetes.org.uk/Documents/About%20Us/Our%20views/Care%20recs/JBDS%20hypoglycaemia%20position%20(2013).pdf.
4
Rucart PA, Boyer-Grand A, Sautou-Miranda V, Bouteloup C, and Chopineau J Influence of unclogging agents on the surface state of enteral feeding tubes JPEN J Paretner Enteral Nutr. 2011 35 2 255 -63
5
Metheny N, Eisenberg P, and McSweeney M Effect of feeding tube properties and three irrigants on clogging rates Nurs Res. 1988 37 165 -9
6
Wilson M and Haynes-Johnson V Cranberry juice or water? A comparison of feeding-tube irrigants Nutr Support Serv. 1987 7 23 -4
7
Nestle Nutrition. HealthCare Nutrition Product Guide; 2010/2011 [cited 2011 Jun 13].
8
Balkany TJ, Jafek BW, and Wong ML Complications of feeding esophagototmy Arch Otolaryngol. 1980 106 122 -3
9
Pichard C, Kyle UG, Morabia A, Perrier A, Vermeulen B, and Unger P Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay Am J Clin Nutr. 2004 79 613 -8