Enteral Nutrition Administration Time

When selecting a feed regimen, consider the type of feed and the safe administration time at room temperature for that feed type. This is referred to as the hang time. There is limited safety evidence for hospital hang times, mostly guided by lab-based studies (Lyman, Gebhards, Hensley, Roberts, & San Pablo, 2011); (Zozaya, et al., 2018); (Castro , et al., 2019); (Lakananurak, Nalinthassanai, Suansawang, & Panarat, 2020) and expert consensus (i.e. American Society of Parenteral and Enteral Nutrition (ASPEN) (Boullata, et al., 2017). Furthermore, there is limited evidence to support an extended hang time in the home setting except when feeding a ready-to-use formula (Lyman, Gebhards, Hensley, Roberts, & San Pablo, 2011). Extended hang times pose a risk to nutrient loss (evidence from breastmilk studies) and for bacterial contamination (Evans, Preston, Daly, Neville, & MacDonald, 2010). 

Fat and energy loss may occur in relation to the feeding set material interacting with the feed type (i.e. breastmilk), and the amount of time required to administer the feed. The highest fat loss occurs in the first 30 minutes of administration, however, fat loss will continue to increase with longer administration times (Castro , et al., 2019) (Zozaya, et al., 2018).

Bacterial contamination in the home setting may be impacted by:

• inadequate handwashing (Evans, Preston, Daly, Neville, & MacDonald, 2010)
• increased feed handling and aseptic technique [ (Evans, Preston, Daly, Neville, & MacDonald, 2010), (Lyman, Gebhards, Hensley, Roberts, & San Pablo, 2011)]
• reduced accuracy of formula preparation compared to the hospital setting (Evans, Preston, Daly, Neville, & MacDonald, 2010)
• complex recipes impacting proper storage of ingredients (Evans, Preston, Daly, Neville, & MacDonald, 2010)
• home enteral feeding greater than 5 years (Evans, Preston, Daly, Neville, & MacDonald, 2010)

Safe extended hang times for ready-to-use formula up to 12 hours can be achieved with reinforcement of proper hand washing, preparing feeds in a clean area, minimizing unnecessary feed handling, and proper storage of breastmilk, formula, and additives. See Table 13.

Table 13: Recommended Hang Times

(Boullata, et al., 2017), (Lyman, Gebhards, Hensley, Roberts, & San Pablo, 2011); (Lakananurak, Nalinthassanai, Suansawang, & Panarat, 2020); (World Health Organization, 2007)