Tube Feedings

https://docs.google.com/document/d/1VFAms16Rm2-6YENIkAhhtsxRLAt3XlnY/edit

EN: Water Flush

EN: kcal - FW = mL of water flush

Enteral Tube Feedings

1. Calculate estimated needs CHO, Protein, Fluid

2. Select TF formula

3. Choose caloric level starting point

4. How much TF to meet caloric needs

   1. Example: 1400 desired kcals / 1.2 kcals/ml  = 1167 ml formula needed

5. See if CHO, Protein, & Fat will meet pt needs

   Convert TF from ml into L

   1. Multiply L of TF with Protein (g)

6. Determine rate of TF

7. Determine free water in TF

   1. mL of water in TF / 1000 = %

   2. mL of TF (#6 rounded) * #7a. = mL free water delivered in x ml of formula

8. Amount additional water is needed to meet estimated fluid needs

   1. x ml fluid needed – x (#7b) ml free water in TF = x ml additional free water needed

   2. Divide the free water

      1. BID | TID | QID

9. Write final TF order

TPN: Lipid solutions

1.1 @ 10% OR 2 @ 20%

TPN: Protein

4

TPN: CHO

3.4

TPN: Fat

10

3 in 1 —> D15%, AA4.25%, IL3.2% at 70ml/hr.

volume of TPN = 1680ml

grams / kcal from CHO = 252gCHO / 856.8kcal

grams / kcal of protein = 71.4g AA / 285.6kcal

grams / kcal for IL = 53.76g IL / 537.6kcal 

total kcal = 1680kcal

CHO Infusion rate = 252g CHO ÷ 79kg (pt weight) ÷ 1440 (min/day) x 1000 (mg/g) = 2.2mg/kg/min

TPN: CHO Infusion

Measures how much CHO is oxidized

g CHO ÷ kg (pt weight) ÷ 1440 (min/day) x 1000 (mg/g) = mg/kg/min

TPN: 2 in 1 — > D25%, AA5.5% at 50ml/hr. 10% IL at 10ml/hr x 12 hr

volume of dextrose/AA solution = 1200ml/d

grams / kcal from CHO = 300g CHO / 1020kcal

grams / kcal of protein = 66g AA / 264kcal

volume / kcal /grams of IL = 120 mL / 132kcal / 13 gm

Total: 1416kcal/d

CHO infusion rate = 300g CHO ÷ 58kg (pt weight) ÷ 1440 (min/day) x 1000 (mg/g) = 3.6mg/kg/min

TPN: Dual Chamber Bag = Fat in upper chamber & dextrose and AA in lower

D20%, AA5%, 150ml 20% IL at 65ml/hr

volume of TPN = 1560ml/d

grams / kcal from CHO = 282g CHO / 959kcal

grams / kcal of protein = 70g AA / 280kcal

kcal /grams of IL = 300kcal / 30 gm

Total: 1539kcal/d

CHO Infusion rate: 282g CHO ÷ 79kg (pt weight) ÷ 1440 (min/day) x 1000 (mg/g) = 2.5mg/kg/min

TPN: Initial Concentration —> 420ml D70, 700ml AA 15%, 200ml 20% IL

grams / kcal from CHO = 294g CHO / 1000kcal

grams / kcal of protein = 105g AA / 420kcal

kcal /grams of IL = 400kcal / 40 gm

Total: 1820kcal/d

CHO infusion rate: 294g CHO ÷ 84kg (pt weight) ÷ 1440 (min/day) x 1000 (mg/g) = 2.4mg/kg/min

TPN: Propofol

1.1kcal/ml