Planning and preparing a kitchen-based (blenderised) tube feed
A blenderised feed is cooked ordinary food, blended, strained and made up to a set volume to give about 1 kcal per mL and 3-4 g protein per 100 mL.
Aim and principles
Aim: To plan, prepare and calculate a kitchen-based (blenderised) tube feed for Mr. S, a stroke patient on a Ryle's tube who needs about 1800 kcal and 65-70 g protein a day. Principles of planning: The feed should be balanced (cereal, pulse, milk, vegetable, oil and sugar), give about 1 kcal per mL so that 1800 mL meets the energy need, and supply about 15% of energy from protein, partly from milk for good quality. It must be smooth, free of lumps and fibres, and thin enough to flow through the tube by gravity or syringe, so foods are cooked soft, blended and strained through a fine sieve. Two feeds are alternated: a milk-based feed (Feed A) with milk, skimmed milk powder, sugar, cornflour and oil, and a cereal-pulse feed (Feed B) with rice, moong dal, vegetables, curd, skimmed milk powder and oil, so the day covers all food groups. Sugar is kept moderate, because very sweet feeds are hyperosmolar and cause diarrhoea. If milk causes diarrhoea, curd is used in place of part of the milk. A pinch of salt goes into the cereal feed. Hygiene is critical: home-made feeds are not sterile and spoil quickly, so they are made fresh, covered, labelled and used within the safe time.
Feed prescription: Mr. S, 65 y, 60 kg, stroke, Ryle's tube
| Item | Prescription | Basis |
|---|---|---|
| Energy | About 1800 kcal | 30 kcal/kg × 60 kg |
| Protein | About 65-70 g | 1.0-1.2 g/kg × 60 kg |
| Feed volume and density | 1800 mL at about 1 kcal/mL | 1800 kcal ÷ 1 kcal/mL |
| Feeds | Six feeds of 300 mL: Feed A three times, Feed B three times | Every 3 hours, 6 am to 9 pm |
| Water | About 2100 mL in all | 35 mL/kg; flushes and extra water make up the rest |
Feed recipes (per 300 mL feed)
| Ingredient | Feed A: milk-based | Feed B: cereal-pulse |
|---|---|---|
| Cereal or starch | Cornflour 10 g | Rice 30 g |
| Pulse | - | Moong dal 20 g |
| Milk products | Toned milk 200 mL; skimmed milk powder 10 g | Curd 50 g; skimmed milk powder 10 g |
| Vegetables | - | Carrot, pumpkin or bottle gourd 50 g |
| Oil | 5 g | 5 g |
| Sugar and salt | Sugar 15 g | A pinch of salt |
| Liquid to make 300 mL | Boiled, cooled water | Cooking water or boiled, cooled water |
| Energy (approx.) | 296 kcal | 297 kcal |
| Protein (approx.) | 9.8 g | 13.3 g |
Day plan: which feed when (Mr. S)
| Time | Feed | Volume |
|---|---|---|
| 6.00 am | Feed A (milk-based) | 300 mL |
| 9.00 am | Feed B (cereal-pulse) | 300 mL |
| 12.00 noon | Feed A | 300 mL |
| 3.00 pm | Feed B | 300 mL |
| 6.00 pm | Feed A | 300 mL |
| 9.00 pm | Feed B | 300 mL |
| Total | 3 × A + 3 × B | 1800 mL |
Preparing the feed
Typical method for one feed of each type; follow your department's recipe and volumes.
- 1★Wash hands; wear a cap and apron; scald the blender jar, sieve, jugs and spoons with boiling water.
- 2Feed B: wash the rice and moong dal and pressure-cook them with the vegetables in plenty of water until very soft.
- 3Cool to lukewarm; add the curd, skimmed milk powder, oil and a pinch of salt.adding curd after cooling stops it splitting
- 4Blend for 2-3 minutes until completely smooth.
- 5★Strain through a fine sieve or clean muslin; throw away any fibre or lumps.
- 6Make up to exactly 300 mL with the cooking water or boiled, cooled water; check that it flows freely from a 50 mL syringe.
- 7Feed A: cook the cornflour in a little of the milk into a thin paste, cool, then blend with the rest of the boiled, cooled milk, skimmed milk powder, sugar and oil; make up to 300 mL with boiled, cooled water.
- 8★Pour into a clean covered flask or jug; label it with the patient's name, bed number, feed, volume and time made; send it at once.
★ one-way, controls the pace
Worked calculation: energy, protein and kcal per mL
Calculate the energy and protein of Feed A and Feed B (300 mL each), the day's total for 3 × A + 3 × B, and the energy density, using approximate values from Indian food composition tables.
- Values used (per 100 g or 100 mL, approximate): toned milk 60 kcal and 3 g protein; skimmed milk powder 357 and 38; cornflour 350 and 0.3; rice 355 and 8; moong dal 325 and 24; vegetables 30 and 1.5; curd 60 and 3; oil 900; sugar 400.
- Feed A: milk 200 mL = 120 kcal, 6.0 g; skimmed milk powder 10 g = 35.7 kcal, 3.8 g; sugar 15 g = 60 kcal; cornflour 10 g = 35 kcal, 0.03 g; oil 5 g = 45 kcal.
- Feed A total = 120 + 35.7 + 60 + 35 + 45 = 295.7 kcal; protein = 6.0 + 3.8 + 0.03 = 9.83 g. Density = 295.7 ÷ 300 = 0.99 kcal/mL.
- Feed B: rice 30 g = 106.5 kcal, 2.4 g; moong dal 20 g = 65 kcal, 4.8 g; vegetables 50 g = 15 kcal, 0.75 g; curd 50 g = 30 kcal, 1.5 g; skimmed milk powder 10 g = 35.7 kcal, 3.8 g; oil 5 g = 45 kcal.
- Feed B total = 106.5 + 65 + 15 + 30 + 35.7 + 45 = 297.2 kcal; protein = 2.4 + 4.8 + 0.75 + 1.5 + 3.8 = 13.25 g. Density = 297.2 ÷ 300 = 0.99 kcal/mL.
- Day: energy = 3 × 295.7 + 3 × 297.2 = 887.1 + 891.6 = 1778.7 kcal; protein = 3 × 9.83 + 3 × 13.25 = 29.49 + 39.75 = 69.24 g.
- Energy density = 1778.7 ÷ 1800 mL = 0.99 kcal/mL; protein = 69.24 ÷ 1800 × 100 = 3.8 g per 100 mL; protein energy = 69.24 × 4 = 277 kcal = 15.6% of energy.
- Compare: energy 1778.7 ÷ 1800 × 100 = 99% of the prescription; protein 69 g is within the 65-70 g target.
Feed A: about 296 kcal and 9.8 g protein per 300 mL; Feed B: about 297 kcal and 13.3 g protein. The day (1800 mL) gives about 1779 kcal (0.99 kcal/mL) and 69 g protein (15.6% of energy). Values are approximate.
Precautions, and result
- Measure every ingredient with a scale or measuring jug; a feed made by eye can differ a lot in energy and protein.
- Make each feed fresh. If a batch is made, refrigerate it at once (4 °C or below) and use within 24 hours; never leave feed at room temperature for more than about 2 hours.
- Bring a refrigerated feed to room temperature by standing the covered container in warm water; do not serve it cold.
- If the feed is too thick, add boiled water and recalculate the kcal per mL; if diarrhoea occurs, check hygiene, temperature, speed and sugar first.
- Result: Feed A gives about 296 kcal and 9.8 g protein per 300 mL; Feed B about 297 kcal and 13.3 g protein. Six feeds (1800 mL) give about 1779 kcal (0.99 kcal/mL) and 69 g protein, meeting Mr. S's needs.
In the diet kitchen, the tube-feed corner needs its own clean blender, fine sieves, measuring jugs and labelled flasks. Standard recipes such as Feed A and Feed B let any cook make the same feed every day, so the patient receives the energy and protein the dietitian planned.
Short answer: “Why is a blenderised feed strained?” To remove lumps and fibres that would block the tube; the feed must flow freely through a 50 mL syringe.
Short answer: “How do you find the kcal per mL of a feed?” Divide the total energy of the ingredients by the final volume; e.g. 296 kcal ÷ 300 mL = 0.99 kcal/mL.
Essay: “Prepare a kitchen-based tube feed for a stroke patient, giving its recipe, volume, energy, protein and kcal per mL.” Aim; principles (balanced, about 1 kcal/mL, 15% protein energy, smooth and strained, moderate sugar, hygiene); recipe table for Feed A and Feed B; method; calculation (296 and 297 kcal; 9.8 and 13.3 g protein; day 1779 kcal, 69 g, 0.99 kcal/mL); day plan; result; precautions.
Cook, Cool, Blend, Strain, Make up, Label, and aim for one kcal per mL.