Hi All,
 
This question is for NICU-affiliated people in particular. The NICU in which I see some of my patients often gives feedings on a syringe pump if the baby cannot orally feed and needs a very controlled feeding delivery time. I recently received the following questions via email from someone on their Clinical Practice Council: 
 
"We will be discontinuing use of the medfusion feeding pumps as they are breaking because they no longer make the pumps or parts in which to fix them. Instead, we will be using the alaris syringe pumps for our pump feedings. These pumps do not have the capability of inverting in order to let the fat rise to the top like the medfusion pumps do. The tubing is a microbore tubing that uses 2ml to prime. Most of our feedings go in over 30-60min, rarely using longer durations or continuous feedings. Does this short length of feeding significantly alter the fat precipitating out and sticking to the tubing? If it does, we are considering flushing the tubing with air if you think there is significant amount of fat sticking to the tubing as opposed to simply using 2 extra mls of milk to prime the tubing. Before we make a feeding change recommendation, we would like your input."
 
My questions/concerns include the following:  Fat rising to the top of the feeding and fat adhesion are both issues to be considered...What impact does type of tubing (not simply microbore vs. "standard" lumen) have on fat adherence? 
Are we using the "best" tubing for enteral feedings that we can? Is there a "best" tubing to use (based on research evidence)?  Would using a standard lumen, rather than a microbore, tube help to minimize fat adhesion?
What are other NICUs doing in terms of pump feeding delivery systems?  I'm not sure what impact either priming the tubing with extra milk or flushing with air has on fat adhesion - is there any hard research on this? 
 
I've looked at the CPQCC Toolkit for info, but I could find nothing beyond positioning the pump/feeding syringe with the tip up - I guess we will no longer be using this type of feeding set-up at all.  
 
What are you NICU-based folks doing along these lines?  Dr. Wight - any thoughts?
 
Thanks for any input,
 
Suellen, in snowy, slushy Indiana, where Spring seems very far away...
 
Suellen Williams, BSN, RN, IBCLC
Women's Services
Clarian Health Partners
Indianapolis, Indiana

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