NUTRITION PUMP WITH NIGHT SETTING

BACKGROUND

[0001] The present disclosure relates generally to devices and methods for incorporating a nighttime setting for systems and pumps used to administer multiple fluids such as enteral feeding solutions. More specifically, the present disclosure is directed to a system and method for improving the user experience for pumps that are operated nocturnally.

[0002] When a patient is unable to eat normally, an infusion set can provide an enteral solution containing nutrition and optional medication to the patient. The infusion set can be used with a pump (e.g., a peristaltic pump) to regulate the amount and the rate at which the enteral solution is delivered from a reservoir to the patient.

[0003] Typically the amount of enteral solution administered to the patient must be precisely controlled, especially if the enteral solution contains potent compounds. In many enteral feeding systems, the engagement of the tube to a peristaltic pump controls the flow of fluid to the patient according to the speed of the peristaltic pump.

[0004] Certain patients and patient settings require continuous enteral nutrition, which can be delivered according to a prescription. Current systems drive the prescriptions according to a set flow rate and a set period of time to achieve a desired total volume delivered. Typically, the prescriptions involve running the pump for an extended duration, spanning an entire day and night at a time. Due to the extended time period required to achieve continuous feeding, many prescriptions typically require nocturnal pumping. With nighttime pumping comes a series of additional complications or annoyances to be rectified that are not typically problems when nutrition deliveries occur with near a non-sleeping patient nearby.

SUMMARY

[0005] The present disclosure provides a continuous or intermittent enteral nutrition delivery system that includes a night-time setting to quiet extraneous noises from the pump to benefit the experience of the patient during sleeping hours. For various reasons, pumps used for delivering nutrition cause undesirable noises when operating in different typical settings. As discussed in detail below, the causes of pump operation noise differ based upon the type of pump, the nutrition prescription, and whether the pump is operating on a battery or connected to AC mains voltage.

[0006] Various embodiments include a pump system for delivering an enteral nutrition composition in a delivery session, the pump system comprising a pump, an input device, a controller, a memory device and a processor. The processor is configured to execute instructions stored on the memory device to cause the controller to enable a user to input a prescription for the delivery session and select a silent operating mode via the input device. When the user selects the silent operating mode, pump system is configured to calculate a silent mode duty cycle profile to achieve a first desired flow rate for the delivery session according to the prescription. The silent mode duty cycle profile is calculated based upon (i) a designated silent operating mode pump speed, and (ii) the first desired flow rate for the delivery session according to the prescription. After the silent mode duty cycle profile has been calculated, the pump operates at the designated silent operating mode pump speed according to the silent mode duty cycle profile.

[0007] Another embodiment includes a pump system for delivering an enteral nutrition composition in a delivery session, the pump system comprising a pump, an input device, a controller, a memory device and a processor. The processor is configured to execute instructions stored on the memory device to cause the controller to enable a user to input a prescription for the delivery session via the input device. The pump is operated at a first pump speed and a first desired flow rate according to the prescription for the delivery session. A user may then select a silent operating mode via the input device. When the silent operating mode is selected, the pump system calculates a duty cycle profile to achieve the first desired flow rate for the delivery session according to the prescription, wherein the duty cycle profile is calculated based upon: (i) a designated silent operating mode pump speed slower than the first pump speed; and (ii) the first desired flow rate for the delivery session according to the prescription. The pump then operates at the designated silent operating mode pump speed according to the second duty cycle profile.

[0008] Another embodiment includes a pump system for delivering an enteral nutrition composition in a delivery session, the pump system comprising a pump, an input device, a controller, a memory device and a processor. The processor is configured to execute instructions stored on the memory device to cause the controller to enable a user to input a prescription for the delivery session via the input device and calculate a first duty cycle profile to achieve a first desired fiow rate for the delivery session according to the prescription. The first duty cycle profile is calculated based upon (a) a first pump speed, and (b) the first desired flow rate for the delivery session according to the prescription. The pump system operates the pump at the first pump speed according to the first duty cycle profile. The user may then select, via the input device, a silent operating mode of the pump system. When the silent operating mode is selected, the pump system calculates a second duty cycle profile to achieve the first desired flow rate for the delivery session according to the prescription, wherein the second duty cycle profile is calculated based upon: (i) a second pump speed, the second pump speed being slower than the first pump speed; and (ii) the first desired flow rate for the delivery session according to the prescription. The pump operates at the second pump speed according to the second duty cycle profile.

[0009] Additional features and advantages are described herein and will be apparent from the following Detailed Description and the Figures.

BRIEF DESCRIPTION OF THE FIGURES

[0010] FIG. 1 shows a graph illustrating the motor speed vs. time of a nutrition pump of a first delivery embodiment.

[0011] FIG. 2 shows a graph illustrating the motor speed vs. time of a nutrition pump of a second delivery embodiment.

[0012] FIG. 3 shows a graph illustrating the applied voltage vs. motor speed of a nutrition pump at a given torque.

[0013] FIG. 4 shows a graph illustrating the power vs. motor speed of a nutrition pump.

[0014] FIG. 5 shows a graph illustrating the efficiency vs. motor speed of a nutrition pump.

DETAILED DESCRIPTION

[0015] As used in this disclosure and the appended claims, the singular forms "a," "an" and "the" include plural referents unless the context clearly dictates otherwise. Thus, for example, reference to "a fluid" or "the fluid" includes two or more fluids. [0016] The words "comprise," "comprises" and "comprising" are to be interpreted inclusively rather than exclusively. Likewise, the terms "include," "including" and "or" should all be construed to be inclusive, unless such a construction is clearly prohibited from the context.

[0017] Nevertheless, the devices and apparatuses disclosed herein may lack any element that is not specifically disclosed. Thus, a disclosure of an embodiment using the term "comprising" includes a disclosure of embodiments "consisting essentially of and "consisting of the components identified. Similarly, the methods disclosed herein may lack any step that is not specifically disclosed herein. Thus, a disclosure of an embodiment using the term "comprising" includes a disclosure of embodiments "consisting essentially of and "consisting of the steps identified.

[0018] The term "and/or" used in the context of "X and/or Y" should be interpreted as "X," or "Y," or "X and Y." Where used herein, the terms "example" and "such as," particularly when followed by a listing of terms, are merely exemplary and illustrative and should not be deemed to be exclusive or comprehensive. Any embodiment disclosed herein can be combined with any other embodiment disclosed herein unless explicitly stated otherwise.

[0019] As used herein, "about" and "approximately" are understood to refer to numbers in a range of numerals, for example the range of -10% to +10% of the referenced number, preferably within -5% to +5% of the referenced number, more preferably within -1% to +1% of the referenced number, most preferably within -0.1% to +0.1% of the referenced number.

[0020] Enteral feeding pumps are devices that control the timing and the amount of nutrition delivered to a patient during enteral feeding. Enteral feeding is the administration of nutrient fluids to a patient who cannot eat via normal ingestion routes. Enteral administration typically occurs through a set of tubes between a feeding bag and a catheter inserted into the patient. A disposable cassette typically carries at least a portion of the tubing so that spent tubing may be easily disposed of.

[0021] Enteral feeding pumps can operate as part of a stand-alone nutrition delivery system or as part of a larger interconnected network of pumping apparatuses, controllers, servers, and databases. For various enteral feeding administrations, a doctor or clinician provides a prescription for an amount (e.g., volume, calories) and duration of continuous feeding or intermittent feeding regimen based upon the profile of each individual patient. [0022] Enteral feeding systems of various embodiments are operable either by being plugged into an AC mains outlet, or alternatively by relying on a battery backup to provide ambulatory functionality. It should be appreciated that having the flexibility of a battery backup is desirable to allow for patient mobility without delivery interruption. However, battery capacity is limited, so the backup battery can only be reliable for a limited duration of time before it must be plugged back into the AC mains outlet and recharged or replaced. It should be appreciated that any suitable level of AC mains voltage connection is appropriate, including but not limited to 100V, 110V, 115V, 120V, 125V, 127V, 210V, 220V, 230V, 240V, or any other suitable voltage level available.

[0023] In various embodiments of the present disclosure, an enteral feeding pump system includes an associated user interface or suitable display device (collectively hereinafter "user interface") that enables interaction between the patient or clinician and the pump system via a suitable associated input device. In various embodiments, a user or clinician, via the input device and user interface, has the ability to at least program the pump with pumping parameters, input a patient prescription, alter pump parameters based upon setting, time of day, prescription, and personal preference, and monitor a continuous or intermittent enteral feeding pump delivery. It should be appreciated that such pump programming inputs may be achieved remotely according to known remote programming methods, as well as locally using an associated input device. In various embodiments, an associated mobile device may be paired to the pump to allow user interaction.

[0024] In various embodiments, it may be desirable for the patient to select whether the pump is operating in a daytime or a nighttime setting or mode (or silent setting or mode). As discussed in greater detail below, the patient or clinician may select one or more nighttime settings from the user interface to configure the pump for nocturnal nutrition delivery. It should be appreciated that in various embodiments, the selection/deselection of nighttime/daytime settings can be manual or automatic (e.g., based upon time of day, ambient light or other known sensors, pump parameters, status of prescription, or any combination thereof). The selection/deselection may also be scheduled on a one-time basis or on a recurring basis. In some embodiments, the nighttime mode cannot be activated unless the pump is plugged into the AC mains voltage. As discussed in greater detail below, nighttime mode will typically drain a battery used for ambulatory pumping at a more rapid rate than normal daytime mode. Therefore, in some embodiments, if the pump is not plugged into the AC mains voltage, the nighttime mode is unavailable for selection by the user in order to protect the battery from accidental drainage.

[0025] Nutrition delivery systems typically employ rotary peristaltic pumps to deliver the nutrition to the patient. It should be appreciated that a rotary peristaltic pump may have an armature attached to a motor. The armature has two or more rollers positioned on the radially distal end of the armature. To pump fluid through a flexible tube, the tube is seated into a raceway so that when the armature rotates, the rollers come into pinching contact with the tube for an arcuate length of tubing within the raceway, forcing liquid forward through the lines. When the motor speeds up, the rollers force liquid along the flexible tube at a higher flow rate.

[0026] In various embodiments, rotary peristaltic pumps do not possess the capability of varying the motor speed beyond one or a few set speeds. In such embodiments, a desired precise higher or lower flow rate may not be achieved simply by speeding up or slowing down the rotational speed of the pump, but by running the pump in 'duty cycles'. Running a rotary peristaltic pump in duty cycles enables the programmer or operator to effectively vary flow rates over time by switching the constant-speed pump on for a calculated period of time and then off for a calculated period of time. It should be appreciated that, for this entire disclosure, the term "motor" may refer to a direct drive motor (with no gearbox) or a motor and gearbox combination. The term "rotations per minute" or rpm are applicable to brushed direct current motors with gearboxes attached.

[0027] Referring now to FIGURE 1, in one exemplary embodiment, DELIVERY A, a rotary peristaltic pump operates at a constant 50 rotations per minute (rpm). It should be appreciated that the interior cross-sectional area of the tubing dictates the amount of nutrition that a 50 rpm motor will pump to the patient. In this example embodiment, flexible tubing is being used that allows 0.20513 ml to be pumped for each full pump rotation. Such a system would produce an approximate pumping flow rate of 10.256 ml minute. Operating uninterrupted at full speed for an hour, this pump would deliver about 615 ml of nutrition to a patient. However, if a prescription called for a target delivery flow rate of only 400 ml in an hour, the 50 rpm pump must be periodically switched off so that it does not over-deliver to the patient. In this case, to achieve the darget delivery flow rate of 400 ml hour instead of 615 ml/hour, a processor and controller cooperate to instruct the pump to switch on for 39 seconds and then switch off for 21 seconds of each minute. In this embodiment, each 39 seconds of operation is one duty cycle: one cycle of being switched on for 39 seconds, after which the pump is switched off for 21 seconds. It should be appreciated that the particular speeds, flow rates, duty cycles and other parameters used for this description are wholly exemplary and not limiting. The settings of DELIVERY A are listed in the table below:

[0028] Referring now to FIG. 1 , a graphical representation of the motor speed vs. time 100 (duty cycle profile) of DELIVERY A is discussed. Specifically, three consecutive duty cycles 102, 104, 106 of DELIVERY A are illustrated. At time T=0, the motor is first switched on at a speed of 114. As discussed above, the initial motor speed 114 in DELIVERY A is 50 rpm. Each duty cycle is represented by operating duration 1 10, followed by non-operating duration 112. Following the conclusion of non-operating duration 1 12, the motor is switched on again at 50 rpm (numeral 1 14) and the duty cycle repeats. The cumulative shaded area under bars 102, 104, and 106 provides the total number of pump rotations of the duty cycles. Knowing the tubing size then allows one to calculate the precise amount of fluid delivered over N duty cycles. Therefore, if the graph of FIG. 1 was extrapolated to include sixty duty cycles (i.e., one hour of operation), then the total area under the bars (102, 104, 106...Ν ₆ ο) could be used with the known tube geometry to calculate the total fluid delivered in the time T = 60 minutes; in the case of DELIVERY A, 400ml.

[0029] As the pump speeds decrease, the operating sound of the pump gets quieter. Therefore, to create a quieter and less disruptive pump for nocturnal feeding when patients are trying to sleep, it is desirable to recalculate the duty cycles and pump configurations to operate at a lower flow rate over a longer duty cycle for the rate of nutrition prescribed. Due to the noise caused by operating pumps at higher motor speeds, even though longer duty cycles would increase the amount of time that the motor is switched on, the lower motor speeds during those longer duty cycles will result in a net decrease of the peak level of noise. [0030] Thus, to improve upon the DELIVERY A example above, the pumping would be quieter and more desirable if the operator could achieve the same total hourly delivery rate (400ml) with a longer duty cycle at a lower flow rate, if possible. In DELIVERY B, outlined in the table below, the same 400ml/hr total hourly delivery flow rate may be achieved using the same flexible tubing internal cross section and the same 1 minute period of operation duration (duty cycle) + non-operation duration (pump switched off), but with the pump operating at 30 rpm instead of 50 rpm. In such a modified system, rather than the pump being switched on for a 65% duty cycle at a higher rate, it would have to be switched on for about a 91% duty cycle, or 55 seconds of each minute. Since the DELIVERY B pump is operating at an rpm that is 40% slower than the DELIVERY A pump, even though the pump operates more continuously in DELIVERY B, the noise of its operation would be much less disturbing.

[0031] Referring now to FIG. 2, a graphical representation of the motor speed vs. time 200 (duty cycle profile) of DELIVERY B is discussed. Specifically, three consecutive duty cycles 202, 204, 206 of DELIVERY B are illustrated. At time T=0, the motor is first switched on at a speed of 214. As discussed above, the initial motor speed 214 in DELIVERY B is 30 rpm. Each duty cycle is represented by operating duration 210, followed by non-operating duration 212 at which time the motor is switched off temporarily. Following the conclusion of non-operating duration 212, the motor is switched on again at 30 rpm (numeral 214) and the duty cycle repeats. Per the table above, for DELIVERY B, the duty cycle, or operating duration 210 of time is 55 seconds at 30 rpm, while the non-operating duration 212 of time is 5 seconds and 0 rpm.

[0032] It should be appreciated that the cumulative shaded area under bars 202, 204, and 206 provides the total number of pump rotations of the duty cycles. Similar to DELIVERY A, knowing the tubing size then allows one to calculate the precise amount of fluid delivered over N duty cycles. If the graph of FIG. 2 was extrapolated to include sixty duty cycles (i.e., one hour of operation), then the total area under the bars (202, 204, 206...N ₆ o) could be used with the known tube geometry to calculate the total fluid delivered, in this case, 400ml. It should be appreciated that, as with DELIVERY A, the speeds, flow rates, duty cycles and other parameters used for this description are wholly exemplary and not limiting. A range of flow rates optimal for nocturnal pumping or "silent mode" is discussed in greater detail below.

[0033] It should be appreciated that the area under each bar between FIGS. 1 and 2 (102 and 202, 104 and 204, and 106 and 206, respectively) is equal. Assuming the same tubing set is used, because these areas are the same, the total fluid delivered over the same sample size of duty cycles in this example will be the same. As seen graphically by comparing FIGS. 1 and 2, the lower motor speed of 30 rpm in DELIVERY B requires a longer duration to achieve the same area as the 50 rpm motor speed of DELIVERY A. It should be appreciated that these two embodiments are simply exemplary to demonstrate the principle of achieving same long term delivery targets using different pump speeds and duty cycle configurations, and are in no way limiting. It should be appreciated that there is a natural limit to lowering the motor speed to attain a given flow rate, i.e., when the motor is turning constantly at a duty cycle of 100%.

[0034] It should also be appreciated that, in various alternative embodiments, each pair of duty cycle duration plus non-operating duration need not be the same between silent pump mode and regular pump mode (i.e., the 1 minute duty cycle plus non-operating duration for DELIVERY A does not necessarily have to equal the duty cycle plus non-operating duration for DELIVERY B). In various embodiments, each operation duration plus non-operation duration may be customized for the silent pump mode to ensure the overall flow rate for the delivery session remains the same, while the pump speed slows down to an optimal (but not too slow) rate. In some embodiments, the processor and controller is configured to monitor real-time pump parameters to calculate and optimize the silent pump mode settings. For example, in some embodiments, the processor and controller of the pumping system are configured to calculate a silent operating mode profile when the user indicates a desire to enter silent mode. It should be appreciated that any number of suitable variables can be considered and incorporated into a silent operating mode profile, including but not limited to: prescription, total fluid delivered in the delivery session, total fluid to be delivered in the delivery session, normal operating parameters (pump speed, duty cycle), time of silent mode activation (immediate or scheduled), patient profile, care setting, line type, pump capabilities, and flow rate. It should be appreciated that, in various embodiments the patient or clinician can schedule the time of entering silent mode for some point in the future (i.e., delay the start of the silent mode). It should also be appreciated that the choice of duty cycle may also be a function of the individual tolerance of the patient. Depending upon condition and health, some patients may not be able to continuously receive a trickle of feed for an extended period defined by the duty cycle recalculations (e.g., 8 hours).

[0035] As discussed above, in various embodiments capable of these and any other features discussed here, the patient's or clinician's interaction with the pump system is possible via an input device either remote from or local to the pump. In some embodiments, the patient can schedule a pump's entry into silent mode via a mobile device paired with the pump system.

[0036] Typical DC motors used for nutrition pumps operate at a constant motor torque. Although not limited to such motors for the purposes of this disclosure, when a constant-torque motor is used, the speed of the motor shaft is controlled by varying the input voltage applied to the motor. It should be appreciated that changing the input voltage can also mean changing a pulse width modulation (PWM) duty cycle to change the current delivered. For example, when controlling brushed DC motors, it is uncommon to adjust the voltage (e.g., from 5V to 2.5V). Instead, typically the 5V input is always applied and the PWM duty cycle is instead changed to 50% to result in half the current being delivered.

[0037] FIG. 3 illustrates a graph plotting the input voltage vs. motor speed of a DC motor. FIG. 4 illustrates a graph plotting output power vs. motor speed of a DC motor. FIG. 5 illustrates a graph plotting efficiency vs. motor speed of a DC motor. It should be appreciated that both DELIVERY A and DELIVERY B profiles are superimposed on FIGS. 3 to 5 for ease of explanation, and are not intended to be to scale. Nor are the curves intended to accurately depict the precise profiles of the respective illustrations.

[0038] Referring now to FIG. 3, the parameters of DELIVERY A and DELIVERY B are plotted to exhibit how applied voltage varies with motor speed for a daytime delivery and a nighttime delivery. In various exemplary embodiments, DELIVERY A operates at col , equal to 50 rpm, which is achieved at an input voltage of VI volts 304. Similarly, when DELIVERY B operates at co2, equal to 30 rpm, the input voltage required is V2 volts 306. Additionally, when discussing specific motor speeds (i.e., DELIVERY A at 50 rpm and DELIVERY B at 30 rpm), it should be appreciated that these exemplary speeds are only intended to be illustrative and not exhaustive. Any suitable nutrition pump motor speeds and delivery rates can be applied to this principle.

[0039] It should be appreciated that, due to the start-up requirement that the motor overcome the internal resistance of its mechanical parts, it does not technically begin turning until the input voltage is at some level greater than zero volts. While the DELIVERY B settings would result in a quieter running experience, it should be appreciated that the DELIVERY B settings would also operate less efficiently then the DELIVERY A settings for reasons discussed and illustrated in FIGS. 4 and 5. Because efficiency will be lower for slower speeds in DELIVERY B, more power is absorbed by the motor, and therefore a greater proportional power input is required than the DELIVERY A settings.

[0040] Referring now to FIG. 4, a graph showing the power vs. rotation speed of a DC pump is illustrated 400. Two curves are illustrated in FIG. 4: the Output Power and the Input Power. Efficiency of a DC motor is highest when the output power is closest to the input power. As discussed in more detail below, the efficiency of the motor is calculated by dividing the output power by the input power. Therefore, when the motor is converting more of the input power to output power, efficiency (OUTPUT /INPUT) is closer to 100%. As the output power decreases as a proportion of the input power, the efficiency of the motor also goes down.

[0041] As seen in FIG. 4, the input power is linear, and the output power is curved, with a peak. The pump speeds of DELIVERY A and DELIVERY B are superimposed on the power v. motor speed graph of FIG. 4, with col rpm producing PI watts of power, and co2 rpm producing P2 watts of power. It should be appreciated that, the motor runs most efficiently at the motor speed which corresponds to the smallest difference between input power and output power. In this case, the most efficient speed is identified at the Max Efficiency (PM), at which point the distance between the Input Power curve and the Output Power curve is minimized, as indicated by distance 408. It should be appreciated that DELIVERY A daytime mode motor speed col is very close to maximum efficiency (as illustrated by distance 404' between Input Power and Output Power), which explains why such speeds are typically used. Also, FIG. 4 illustrates the relative inefficiency of the DELIVERY B nighttime mode at motor speed co2. The distance 406' between Input Power and Output Power of DELIVERY B is much greater than the col DELIVERY A speed efficiency 404' or the optimal efficiency 408. [0042] As discussed above, to calculate the efficiency of a DC motor, the mechanical output power that the motor can deliver (illustrated in FIG. 4) is divided by the power that the motor absorbs (input power). It should be appreciated that the output power and the absorbed power vary in relation to the speed of motor rotation.

[0043] Referring now to FIG. 5, a graph illustrating the efficiency of DC motors is illustrated. As a general principle, a DC motor attains maximum efficiency when it operates at greater than 50% of its no-load speed. Therefore, when the pump runs below 50% of its no-load speed, the efficiency of the motor is decreased. Maximum efficiency (nearest to 100%) is achieved at 502 of the efficiency-to-motor speed graph 500 illustrated in FIG. 5. Due to losses from heat, friction, etc., pumps can never reach true 100% efficiency, but the graphs and models discussed herein show a hypothetical frictionless embodiment to convey the principles. It should be appreciated that the motor speed at 502 of FIG. 5 is equal to the motor speed at 408 of FIG. 4. At the DELIVERY A speed of col rpm (i.e., daytime running mode for the present exemplary embodiment), the motor is running at efficiency El%, which can be identified at point 504 on the efficiency curve 510. During the DELIVERY B nighttime mode, the motor operates at speed co2 rpm. FIG. 5 shows that the efficiency of the motor E2% is significantly lower at point 506 of the efficiency curve for DELIVERY B than for DELIVERY A.

[0044] Thus, it should be appreciated that operating the pump at a lower speed to achieve an ancillary goal (e.g., to quiet it down for 'silent mode') has the side effect of making the motor run with less efficiency. There are various drawbacks to running a pump at a lower speed (i.e., "silent mode") that must be overcome. It should be appreciated that running in silent mode (low speed) may put an unacceptable burden on a battery life for current systems used for ambulatory purposes. In various embodiments, either a higher capacity battery would be required to operate in silent mode, or the setting would only be available when the pump system is plugged into the AC mains voltage. In addition to operating less efficiently, operating in silent mode in various embodiment impacts heat generation, service life, and maintenance required. Silent mode may also require a recalibration of occlusion alarm sensors and routines to detect same. It would be desirable to decrease the motor speed to quiet the pump noise during nocturnal pumping while minimizing the above drawbacks of running with lower efficiency. Many of the drawbacks listed above are eliminated entirely if the pump is constantly plugged into the AC mains voltage when running in nighttime mode. The trade-off of tethering the pump to an AC outlet during nighttime mode is worth the exchange for a quieter nocturnal operation and improved patient comfort.

[0045] In some embodiments, the silent mode is the most effective for prescribed rates under about 300 ml/hour. In other embodiments, the silent mode is the most effective for prescribed rates under about 290 ml/hour. In other embodiments, the silent mode is the most effective for prescribed rates under about 280 ml/hour. In other embodiments, the silent mode is the most effective for prescribed rates under about 270 ml/hour. In other embodiments, the silent mode is the most effective for prescribed rates under about 260 ml/hour. In other embodiments, the silent mode is the most effective for prescribed rates under about 250 ml/hour. In other embodiments, the silent mode is the most effective for prescribed rates under about 240 ml/hour. In other embodiments, the silent mode is the most effective for prescribed rates under about 230 ml/hour. In other embodiments, the silent mode is the most effective for prescribed rates under about 220 ml/hour. In other embodiments, the silent mode is the most effective for prescribed rates under about 210 ml/hour. In other embodiments, the silent mode is the most effective for prescribed rates under about 200 ml/hour. According to various typical enteral feeding prescriptions, nocturnal feeding tends to require lower hourly flow rates (e.g., but not limited to about 100 to 150 ml/hour). It should be appreciated that, however, that higher flow rates are also contemplated for being run in night mode according to the discussion herein.

[0046] In various embodiments, the pump system of the present disclosure is capable of a nocturnal silent mode, which is operable as one of a suite of "night mode" settings available to the patient or operator. For example, a panel of night mode settings could include (but is not limited to) the following options:

[0047] a. Silent pumping mode - running the pump slower to reduce its noise, as discussed above

[0048] b. Auto-dim - automatically switch on the auto-dim function of a screen or user interface.

[0049] c. Light control - automatically switch off all machine LEDs or other lights

[0050] d. Delayed start - allowing the patient or operator to schedule a nutrition delivery start time or pause the actual nutrition delivery start to allow the patient to fall asleep before the pump starts pumping [0051] e. Silence local alarms - any local alarms occurring to a patient under the care of a healthcare professional would be silenced at the pump, and rerouted to a remote monitoring location (e.g., nurse's stand, cell phone, hospital network, etc.). In addition to rerouting alarms, alarms could be rerouted initially, and then reinstating them on the pump after a certain period of time (e.g., if a downstream occlusion detected is not addressed within one hour, the alarm is initiated on the pump). If, additionally, the alarm is not addressed locally after a period of time, the volume of the alarm can be increased to the loudest level.

[0052] f. Increase alarm volume - make alarms louder if an alarm is not addressed after a period of time, or for autonomous elderly patients to ensure a deep sleep is interrupted in case of an unsupervised emergency

[0053] g. End of therapy - turn off end of therapy alarm

[0054] h. Night mode exiting - the first press of any button while in night mode turns off night mode and thus replaces the initial button function. Exiting night mode could also be initiated: after some period of time (e.g., returns to normal after 8 hours); changing any of the features automatically changed by night mode (e.g., switching Autodim off would automatically revert from night mode back to normal mode); or based on a prompt appearing when the pump is restarted, such as "Would you like to continue in night mode?"

[0055] It should be appreciated that the grouping of one or more selective night mode options allows the patient or operator to customize the nocturnal pumping experience on a case- by-case basis, capable of being activated via a single menu setting.

[0056] Various changes and modifications to the presently preferred embodiments described herein will be apparent to those skilled in the art. Such changes and modifications can be made without departing from the spirit and scope of the present subject matter and without diminishing its intended advantages. It is therefore intended that such changes and modifications be covered by the appended claims.