Written by Amanda Sullivan, RD, CD, CNSC

Whether traveling for business or pleasure, you can feel relaxed and safe while on tube feedings with a bit of planning ahead. This article contains tips from experienced tube-fed travelers and home infusion company representatives.

Plan Ahead

Planning well in advance will save you time and hassle for a stress-free vacation or business trip.

Documents

A suggested list of documents to bring with you on your trip is available through the Oley Foundation website ht

tp://www.oley.org/documents/travel.pdf. These documents are meant to help you communicate your medical needs to airport Transportation Security Administration (TSA) and/or hospital personnel, if for any reason you needed to seek medical attention at an unfamiliar hospital while traveling.

“TSA in the U.S. at some airports is improving. If I am flying, I take Ensure, rather than Jevity, because they can scan the plastic bottles without even opening them.” –Steve Barclay

Formula/Supplies

Know what type of feeding tube you have and what your options are for methods of administration (bolus syringe, gravity bag, or pump). For example, if you use the gravity method could you use the bolus syringe method instead to reduce the amount of supplies you need to bring with you on trip?

Tube Type	Bolus Method	Gravity Method	Pump Feedings	Special Considerations
Gastric Tube (aka PEG or G-tube)	Yes	Yes	Yes	None
Gastric-Jejunal Tube (aka GJ-Tube)	If feeding through the G-port, yes	If feeding through the G-port, yes	Yes	-IV pole or other device to hang bags from
Jejunal Tube (aka PEJ or J-tube)	No	No	Yes	-Outlets for charging pump if traveling abroad-Pack an extra pump in case of damage

Talk to your dietitian/medical team to discuss what delivery and administration options would be most appropriate for you.

Contact your home infusion company to learn how they can help coordinate delivery of tube feeding formula and/or supplies to your travel destination. This will save you the worry and hassle of carting it through busy airport terminals and then to your final destination. Be careful, though, as the delivery will come out of your regular monthly order; giving the home infusion company one to two months notice will help them prepare for the special shipment.

Back-up plan

In case of lost baggage, delayed deliveries, or long flights, pack 1-2 days’ worth of formula in your carry-on bag. This is where having a letter written by your doctor explaining the medical necessity of the formula will come in handy—letter template available through the Oley Foundation website (link above).

“I carry a letter from my Internist attesting to the necessity of my having food on board the aircraft. But experience differs a great deal—in Taiwan they hardly look at the letter. In Japan they find someone with English skills and examine it in great detail. In Ireland they suggested I get a new letter, since the one I have is 2 years old.” –Steve Barclay

Before leaving on your trip, locate the nearest hospital, medical center, and/or emergency department in the city you are traveling to so you know where to go to seek medical attention if necessary. Have the address and phone numbers handy in case of emergency.

“We’ve even had patients who’ve run out of formula on vacation reach out to hospitals or agencies in their area to help with a 1-2 day supply.” –Home Infusion Representative

Research to see what stores and/or pharmacies are in the area you are traveling to. Call to see if those stores/pharmacies carry your formula or oral nutritional supplements like Ensure (Plus), Boost (Plus), Orgain products, or store brand equivalents. If you normally use a standard formula (Isosource 1.5, Osmolite 1.5, Osmolite 1.2, Nutren 1.5, etc.), talk to your dietitian to see if using an oral nutritional supplement would be an option for you while traveling. If so, you may want to trial the formula before your trip to make sure you tolerate it well.

For example, if you normally infuse 5 cartons of Isosource 1.5 (1875 calories) per day you could substitute with 5 cartons of Boost Plus (1800 calories) per day.

“When I went to the U.K. and Ireland last summer, I was able to arrange through a local contact to order Jevity through a local pharmacy. “ –Steve Barclay

“In Sardinia, I was able to find Ensure Plus in almost every pharmacy.” –Steve Barclay

Pack some Carnation Breakfast Essentials packets or individual protein powder packets (such as Vega One Nutritional Shake) in your suitcase. Once you are through security, purchase a bottle of water or milk, mix it with the powder, and administer through your tube. One packet of Carnation Breakfast Essentials mixed with 8 ounces whole milk would provide 290 calories and 13 grams protein. One packet of Vega One mixed with 8 ounces whole milk would provide 330 calories and 28 grams protein.

You may also choose to supplement or replace your standard formula with homemade (or purchased) blenderized food while traveling (always consult with your medical team before switching formulas or trying blenderized foods). Consider a cordless rechargeable hand blender, instead of a bulky standing blender, to blend your foods while traveling. See below for samples of homemade blenderized meals.

Traveling within the United States

Traveling by car? Can you pack enough formula/supplies to last the duration of your travels in the trunk of your vehicle?

If not, talk with your home infusion company to see if they would be able to send formula/supply deliveries to your travel destination. Depending on the state (or the nature of your travels), your home infusion company may be able to work with an affiliate to get the formula/supplies you need to your destination. When shipping from Washington, it takes on average:

• 1 day to get anywhere in Washington, Northern Oregon, and Northern Idaho
• 2 days to Central California, Utah, Central Montana
• 3 days to Southern California, Arizona, Colorado, and parts of North Dakota
• 4 days to most of the Midwest (as far East as Missouri) and parts of Northern Texas
• 5-6 days to everywhere else

Keeping in mind weather conditions can change delivery times!

International Travels

Home infusion companies typically don’t ship outside the United States because of the additional shipping costs and special instructions. And although Hawaii, Alaska, and Puerto Rico are part of the United States, home infusion company representatives recommend treating them like your traveling internationally. Weigh your options to see which method of transport would be best, keeping in mind shipping costs and potential delays. Would paying the extra luggage fee to take formula and supplies on the flight be a feasible option?

“Using hospital2home group, Abbott labs in the UK will assist you with your supplies if you make arrangements ahead of time” –John Martin

“When traveling for business my OA would ship cases of my food to Taipei or Tokyo, or wherever I was going.” –Steve Barclay

“Once we had a patient [traveling to Hawaii] ship their formula and supplies via USPS, [but what] they didn’t realize is that their shipment was put on a barge and took 3 weeks to arrive” – Home Infusion Representative

Visit the Oley Foundation website for more tips: http://www.oley.org/traveltips.html

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Samples of Blenderized Meals

Breakfast

Blenderized together until liquefied; then strain if needed:

½ cup pasteurized liquid egg

½ cup cooked whole grain cereal

1 cup kefir or drinkable yogurt

8 ounces cup juice or water

½ cup fruit and/or vegetables

1 Tablespoon oil such as walnut, coconut, flaxseed, or canola oil

Snack

Homemade or store bought fruit and/or vegetable juice

Lunch or Dinner

½ cup diced cooked skinless chicken, fish, or garbanzo beans

12 ounces vegetable juice

½ cup cooked vegetable such as squash

½ cup cooked brown rice, whole grain pasta, or quinoa

1 cup milk (any milk—cow, soy, almond, rice, flax, etc.)

1 Tablespoon oil such as olive hazelnut or canola

Important points:

• Remember to flush your feeding tube with water before and after food or medications to prevent from clogging.
• Always wash your hands and use standard safe food handling practices.
• Allow foods to reach room temperature before administering through your tube.
• If your blenderized formula is not completely smooth, strain it through a fine-mesh sieve before administering it through your tube.
• Add more liquid (water, broth, milk) than the recipe calls for, if needed, to get the blenderized food to the right consistency.