We are interested in finding out more about the nutrition and dietary choices used among both adult and pediatric tube feeders.
Tube feeders, we ask that you complete the questions based on your experiences.
Parents and caregivers, please complete the questionnaire based on one tube feeder in your care. If there is a second or third tube feeder in your care, you will need to complete a separate survey on another device.
We ask that you answer the questions based on what you/your loved one are currently using today.
If you have taken this survey before, please do not complete survey.
Which of the following best describes you?
* must provide value
Adult tube feeder
Caregiver for an adult tube feeder
Parent or caregiver of a pediatric tube feeder
Gender
* must provide value
Male
Female
Current age (in years)?
* must provide value
How long have you/your loved one been on tube feeding?
* must provide value
Less than a month
1 - 6 months
7 months to up to 1 year
1 year - 5 years
Greater than 5 years
What type of feeding tube do you or your loved one have?
* must provide value
Nasogastric (NG)
Nasojejunal (NJ)
Gastrostomy (G) PEG/Long-tube
Gastrostomy (G) Button/Low-profile
Gastrojejunal (GJ) PEGJ/Long-tube
Gastrojejunal (GJ) Button/Low-profile
Jejunal (J)
Foley catheter
Red rubber catheter
Don't Know
What is the French size of the feeding tube?
* must provide value
4-5 french
6 french
8 french
10 french
12 french
14 french
16 french
18 french
20 french
22 french
24 french
26 french
28 french
Don't know
Foods, drinks (including formula and breast milk) consumed orally
* must provide value
Breast milk that is tube fed
* must provide value
Formula that is tube fed
* must provide value
Blenderized tube feeding
* must provide value
Do you use formula via tube feeding?
* must provide value
Yes
No
Which formula are you or your loved one currently using?
Standard formula (such as Jevity, Nutren, Nutren Jr., Pediasure)
Peptide based formula (such as Peptamen, Peptamen Jr., Pediasure Peptide)
Specialized formula for the treatment of specific medical conditions (such as Tolerex, Renalsource, Elecare, Neocate)
Formula with real food (such as Compleat, Compleat Pediatric)
Commercial blenderized tube feeding (such as Real Food Blends, Liquid Hope, Liquid Hope Nourish)
Other, specify in text box below
How interested are you in using whole foods in your/your loved one's tube feeding diet?
Extremely interested
Very interested
Somewhat interested
Not very interested
Not interested at all
Do you consume blenderized food via tube feeding?
* must provide value
Yes
No
Which of the following best describes the blenderized tube feeding you/your loved one uses?
Formula with real food (such as Compleat, Compleat Pediatric)
Commercial Blenderized tube feeding (such as Real Food Blends, Liquid Hope, Liquid Hope Nourish)
A blend of packaged baby foods
Home blended foods using a blender
Home blended foods using a blender with commercial formula
Other, specify in text box below
Have you/your loved one experienced challenges getting tube feeding formulas or commercial blended foods covered by insurance, Medicare, or Medicaid?
Yes, and it was not resolved
Yes, but it was resolved and covered
No
I use my own blenderized tube feeding and do not receive reimbursement
Have you/your loved one experienced challenges getting tube feeding supplies (syringes, tubing, feeding tube, etc.) covered by insurance, Medicare or Medicaid?
Yes, and it was not resolved
Yes, but it was resolved and covered
No
I use my own blenderized tube feeding and do not receive reimbursement for supplies
Please explain the coverage challenges for tube feeding formulas or commercial blended foods.
Which of the following describe why you/your loved one uses blenderized tube feeding?
It makes me feel "normal"
I/My loved one can tolerate it better
I /My loved one like eating what my family eats
It is more natural
I don't like the ingredients in commercial formulas
I/My loved one have food allergies
It makes it easier to travel
Other, specify in text box below
Which of the following symptoms did you/your loved one experience when using commercial formula?
Nausea
Vomiting
Fever
Gas/Bloating
Diarrhea
Constipation
Pain
None of these
Never used commercial formula
Other, specify in text box below
Which of the following symptoms have you/your loved one experienced when using blenderized tube feeding?
Nausea
Vomiting
Fever
Gas/Bloating
Diarrhea
Constipation
Pain
None of these
Other, specify in text box below
What is the current employment status of the primary person responsible for preparing blenderized tube feeding?
Working full-time
Working part-time
In school full-time
In school part-time
Does not work or attend school
What blender are you currently using for your home blenderized tube feeding?
Vitamix
BlendTec
Ninja Professional
Ninja (other model)
Other, specify in text box below
Do you pass the blend through a sieve or strainer before feeding?
Yes, all the time
Yes, but only if needed
No
Have you ever worked with a registered dietitian to get recipes or review the diet for home blenderized tube feedings?
Yes
No
Don't Know
How often do you typical prepare blenderized tube feeding?
Every meal
Once a day
Every couple of days
Once a week
Other, specify in text box below
We are trying to understand the types of foods and ingredients that are used in blenderized tube feeding. Please indicate which of the following foods you often include in blends. (select all that apply)
How much additional water or fluids do you administer through the feeding tube each day for hydration and flushes (in oz)?
24. How long do you typically blend your blenderized tube feeding in your blender of choice? (Select one)
5 minutes or longer
Between 3-5 minutes
Between 1-3 minutes
1 minute or less
Variable and dependent on the ingredients
How often do you add fluid (water/milk/milk alternative/broth/juice) to make your blenderized tube feeding thinner before feeding it?
Very often
Sometimes
Not very often
Never
How do you feed the blenderized tube feeding? (select all that apply)
Which pump are you using to deliver the blenderized tube feeding?
Moog Infinity (Teal or Orange)
Kangaroo Joey
Kangaroo Connect
Kangaroo e pump
Compat
Sentinel
Other, specify in text box below
Which of the following best describes the blenderized tube feeding schedule delivered via pump?
Continuous feeds - feeds run over many hours
Bolus feeds -feeds that take about as long as a meal
Intermittent feeds - feeds that run for a couple of hours and then have longer breaks in between
Other, specify in text box below
What is the average pump rate you use to deliver the blenderized tube feeding? [OPEN END] [MAX 600]
What is the typical volume delivered by pump in a feeding?
What syringes are you using most often for delivering the blenderized tube feeding?
O Ring
Plunger/Gasket syringe
Other, specify in text box below
What is the tip on the syringes you use most often?
Catheter/Cath tip
Oral tip
Slip tip
Other, specify in text box below
What cc/ml size syringe are you typically using to deliver blenderized tube feeding?
60 cc/ml
100 cc/ml
Other, specify in text box below
How much blenderized tube feeding is typically consumed at each meal? (in ml)
How many times do you typically use a syringe for feeding before discarding?
How long (in minutes) does each meal typically take to deliver?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Pouring into the syringe?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Not applicable
Drawing up feed into the syringe?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Not applicable
Connecting to the feeding tube?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Not applicable
Delivery - push with syringe plunger?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Not applicable
What change in your current blenderized tube feeding system would improve its ease of use significantly?
* must provide value
How often does your existing feeding tube system clog?
* must provide value
Very often (daily/several times a week)
Often (once per week)
Occasionally (monthly/couple times a month)
Rarely (once to a few times a year)
Never
What is typically the cause of the clogging?
Blended foods
Medications
Other, specify in text box below
Where is the clog usually located?
Syringe tip
Extension set tubing
Where the extension set connects to the button/low profile device
Feeding Tube
How do you typically clear a clog?