This information will provide clinical suggestions and information to meet potential supply challenges. EN demand will likely increase due to the large number of ventilated, critically ill patients. In general, purchase only as much supply as needed considering patient projections. In the interest of patient safety and fair allocation to all patients nationally, please do not stockpile. We believe manufacturers are increasing production capacity in response to the increase demand.
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General
For any supplies that are not disposable that need to go into a patient’s room or care area, clean them similarly to the cleaning protocol that you would use for ventilators or other non-disposable equipment, and in accordance with the manufacturer’s instructions.
Formula
- For EN formula, evaluate your formula supply and choices for these patients.
- Consider contacting all sources of similar product including those outside of your usual supply chain to obtain formula.
- Be flexible with formula brand, type, and container and as needed.
- Note your institutional and/or manufacturer’s substitution lists.
Feeding Tubes
- There may be a larger demand on nasogastric and nasoenteric short term feeding tubes.
- Consider using an existing nasogastric tube for feeding.
Administration Sets and Pumps
Best use of current inventory:
- Prioritize enteral feeding pumps and pump administration sets for those patients receiving post-pyloric feeding and/or those intolerant of intermittent gastric feeding.
- In those patients who receive continuous feedings but do not have an enteral pump available, use administration sets with roller clamps to control gravity drip rate. Consider bag height, fluid viscosity, diameter of feeding tube along with other factors that impact the flow rate.
- When using gravity administration, to decrease the potential for adverse events of free flow of a large volume of formula, fill the administration set with the least amount of formula needed at a time or use the smallest ready-to-hang formula bag available.
- If the enteral pump is to be housed outside the patient’s room, use extension tubing and consider the recommendations outlined here.
When looking for more pumps:
- If you do not have enteral pumps available from your usual vendor, reach out to alternate brand companies to check their supply.
- Reach out to different levels of the supply chain such as warehouses and distributors for supply. Also consider medical equipment rental companies.
- Reach out to Global Enteral Device Supply Association (GEDSA) for alternative companies and supply information.
- Don’t forget that if you are able to get a different brand enteral pump, you will need to get those same brand pump sets as the sets are usually not interchangeable between brands.
- Consider sharing a pump between COVID-19 positive patients for either intermittent or cycled feedings.