Kangaroo Joey

We tried using a new feeding pump, the Kangaroo Joey, for a month. It certainly has some nice features and I like its user interface and options. It alarms when the feeding is done and the alarm's volume is adjustable. It seems to have more accurate measurements marked on the feed bags than the Zevex Infinity system. It has multiple advantages, but it was not a good fit for us.

We use Elecare formula and it is a powder that has to be mixed. Apparently, powder formulas do not operate well in the Kangaroo system because it has a back-flow prevention valve that is pretty sensitive. The company who makes the Kangaroo stated we would have to blend the formula if we did not want there to be any problems. We noticed however, the post that turns the back-flow prevention valve on the feed set would get out of alignment and make it difficult to insert the set into the machine. We would notice this mainly when the tab on the set would not be centered in its corresponding hole on the pump door. The tab would actually be resting against the outer edge of that hole and would push back once the pump started. Then this would pop the door open and the pump would fail to function. We traded the pump out twice and never could figure out why this kept happening. Our best guess is that something was not quite right with the feed sets.

There are a lot of features we like about this system, but we did not find it to be reliable. We also noticed that the volume it dispensed was inaccurate. It would indicate it had delivered 250 ml of formula but we could tell less had been given. We actually measure our formula with a scale to ensure the volumes are correct. What we mixed and what the pump gave often varied by quite a bit. So, we have gone back to the Zevex pump and are dealing with the issues it presents. But it seems to be more accurate and is not as sensitive to mixed formula.

Kangaroo Joey vs. Zevex Infinity

We have switch feeding pumps from the Zevex Infinity to the Kangaroo Joey. Like anything there are pros and cons to either system. But so far, I prefer the screen and interface of the Joey over the Infinity. Without having to change screens, you can view where you are in a feeding. It doesn't seem to be as finicky once it is loaded and running. The Zevex can alarm often if the bag's set is not loaded perfectly or if one sensor is not happy about its readings. The alarming can be frustrating and hard to diagnose. However, actually loading the Joey has proven to be a bit troublesome. There is a back flow prevention valve in the tubing that has to be set in all the way for it to operate properly. Sometimes you have to push it in quite forcibly to make sure it is seated. The good thing is you know immediately if it is not seated correctly because the door on the pump will not stay closed if it is wrong. I also like how the feed bag is similar to an IV bag and more accurately shows the amount of formula inside. The Zevex feed bags, at least the 500 ml bags, were not accurate in their markings. The Joey also has a faster priming function.

The Zevex does have the advantage in portability and positioning. The Joey requires six inches of fall between the bag and the pump, where as the Infinity can be position any where as long as all the air is out of the bag. The Infinity pump is flatter than the Joey and fits well in most places. The Joey is more cube-like. With Macayla being less mobile these days, we do not have to have these benefits of the Infinity, but for active children, the Infinity is great. The Infinity's door has problems with the latch breaking, but I heard the company is trying some other types of plastics to fix this.

The Joey is new to us and we are waiting on a backpack for it and after we have had more time to learn it, I will post more if needed on troubleshooting.

Zevex Feeding Pump Trouble Shooting II

The only other time I have had a problem with this feeding system, is when you load the bag full of food and the tubing is primed but every time I push the "Run/Pause" button, it tells me "No Flow Out" immediately. In other words, the pump did not even push any formula and it gave me this reading. I will double check the tubing to make sure it is not crimped. I manually push formula through and it flows fine, but the pump still says there is no flow out. This happened twice a month or so and if I changed bags, it solved the problem. However, that means a whole bag was wasted and our equipment provider is a stickler for only sending the order out when they can bill for it and not a day sooner.Then I discovered the culprit. If you look at the blue set that goes in the pump, you will notice how it is attached to the clear plastic.

Notice the blue nodules that insert up into the clear plastic on both sides. I discovered that if one of those is not fully seated, the pump will not function. It must be pushed up into the clear plastic as far as it can.

This little deviation in the blue tubing stops everything. But it is simple enough to fix and that means less feed bags lost.

Zevex Feeding Pump Trouble Shooting

Check out the first post below about this pump system. As I mentioned there, we have been happy with the system, but there are times when it fails or causes frustration. I invite any others who are familiar with this pump to add their experience here as well. Or let us know if you have used or seen a better system.

The latch on the pump door will weaken over time and break from normal use. It is part of the molded plastic door and is flexible, but within 8 months, it will begin to crack and break off. This is a problem since the pump will not operate unless the door is latched closed. Usually, the equipment provider can switch out the pump for you, but this takes time and feedings cannot stop while you wait for a replacement. The first sign of the cracking is when the latch feels looser than normal. Then, if you look closely, you will notice a hairline crack across the top of the latch.

We have found a couple of ways to deal with this. Before the latch piece actually breaks off, I will cut a strip off of an index card length wise and then fold it in half over and over until it is the right thickness to wedge under the latch. (see the next photo) It just has to be thick enough to firm up the latch so that it can still flex enough to work, but not flex as far as it was. By making it tighter, it gives more time before it actually will break off.

Once it does break off, the pump door will no longer stay closed and therefore not function. To remedy this, we have used the velcro strap inside the backpack (the larger one only) to strap the pump in place tight enough to hold the door closed. 

The straps in the mini backpack will not do this. The only problem is that the elastic in this strap will wear out over time and not hold the door as well. So, there is a small size bungee cord that works perfectly. As far as I know, it is the smallest one they make. After the set from the bag is installed over the wheel and the pump door is closed, this cord will hold the door closed tight enough for it to function.

These are just a couple of things we have done to make this system work while waiting on a replacement pump or just the replacement door for the pump. I have emailed the company about its design, but they have yet to respond. There is another couple of flow problems I will talk about in the next post.

Zevex Feeding Pump

Macayla has a Zevex Enteralite Infinity feeding pump. It is a good system and she has used it for over two years now. We have enjoyed its portability and adjustability. It can be carried in a specially designed backpack and does not rely on gravity to work. It can be attached to a pole for bedtime as well with the pole clamp that is included. We wanted to include a few posts on this pump and point out a few troubleshooting ideas we have learned over the last two years using this pump.

 First, many nurses may not be familiar with they system as it differs from most hospital pumps. It is compact so many of the buttons on it do two functions. For example, the Run/Pause button is one button used to start the pump and stop the pump. The Vol/Total button is pressed once to show the current volume and if it is pressed again it will show the Total volume for the day. If you press the this button once and show the current volume and press the Clear button, it will only clear out the current volume and not the Total Volume. Since our daughter has struggled at various times to tolerate food, it has helped to be able to keep track of the Total volume throughout the day and only clear it before starting the next day's feeding. 

Basically the pump works like this:

Each bag (available in 500 ml or 1200 ml sizes) have a specially designed set that fits over the pump wheel. The door then shuts over it and must be closed in order for it to work. Then it is a matter of turning it on, setting the rate and dose and getting it started. There is a catheter tip (cone shaped) on the end of the tubing that fits into feeding tube connectors. So, it will mesh with most feeding tubes. The gray rectangle in the photo is the screen that indicates all the settings.

 

The pump has a Prime button on it, so you can fill the bag, install the set over the pump wheel, close the door and then press and hold the Prime button. It will push formula all the way through the tubing. But there is a faster way to do this. If you will notice in these photos there is a "longer" side to the set. On that longer side, you will see a teardrop shape on the blue tubing. It indicates the spot that must be pressed in order for the formula to flow through. There is a small stem inside the tubing and when it is pressed down or over, it allows formula to flow. 

I use my thumb and push the teardrop section of the blue tubing while holding the filled bag. With pressure on the bag and gentle pressure on the blue tubing, the formula will flow quickly to prime the rest of the tubing. If you hold the bag upside down and allow all of the air to reach the tubing first, then there will be no air left in the bag and it won't matter if the bag is upside down, sideways or any other direction. Gravity will not be needed to keep the formula flowing. 

Overall, a good system. However, it takes a little practice to prime the tube by hand. Sometimes those sets (the blue tubing portion) fail and cause the pump to not work. I'll deal with that in the next post.