Tube Feeding

Tube Feeding Orders

Administration Types

  • Start Tube Feeding (TF) via:

    • Nasogastric Tube (NGT)

    • Orogastric Tube (OGT)

    • Naso-Duodenal Tube (NDT)

    • Percutaneous Endoscopic Gastrostomy (PEG)

    • Jejunal Tube

Administration Methods

  • Options:

    • Continuous

    • Bolus

    • Intermittent

Types of Formula

  • Osmolite 1.2:

    • Caloric Density: 1.2 kcal/mL

    • Protein: 55.5 grams/liter

    • Free Water: 82%

    • Micronutrients: Meets or exceeds RDIs in 1200 mL

  • Jevity 1.2:

    • Caloric Density: 1.2 kcal/mL

    • Protein: 55.5 grams/liter

    • Free Water: 81%

    • Micronutrients: Meets or exceeds RDIs for 1250 mL

    • Dietary Fiber: 17 g/liter

  • Osmolite 1.5:

    • Caloric Density: 1.5 kcal/mL

    • Protein: 63 grams/liter

    • Free Water: 76%

    • Micronutrients: Meets or exceeds RDIs in 1000 mL

  • Jevity 1.5:

    • Caloric Density: 1.5 kcal/mL

    • Protein: 63.8 grams/liter

    • Free Water: 76%

    • Micronutrients: Meets or exceeds RDIs in 1000 mL

  • Pivot 1.5:

    • Caloric Density: 1.5 kcal/mL

    • Protein: 93.8 grams/liter

    • Free Water: 75%

    • Micronutrients: Meets or exceeds RDIs in 1000 mL

  • Glucerna 1.2:

    • Caloric Density: 1.2 kcal/mL

    • Protein: 60 grams/liter

    • Free Water: 81%

    • Micronutrients: Meets or exceeds RDIs for 1250 mL

  • Two Cal HN:

    • Caloric Density: 2 kcal/mL

    • Protein: 83.5 grams/liter

    • Free Water: 70%

    • Micronutrients: Meets or exceeds RDIs in 948 mL

  • Vital AF 1.2:

    • Caloric Density: 1.2 kcal/mL

    • Protein: 75 grams/liter

    • Free Water: 81%

    • Fiber: 5 grams/liter

    • Micronutrients: Meets or exceeds RDIs in 1185 mL

  • Vivonex Plus:

    • Caloric Density: 1.0 kcal/mL

    • Protein: 45 grams/liter (100% free amino acids)

    • Fat: 6.6 grams/liter

    • Free Water: 83%

    • Fiber: 0 grams

    • Micronutrients: Meets RDIs in 1800 mL

  • Vital High Protein:

    • Caloric Density: 1 kcal/mL

    • Protein: 87.3 grams/liter

    • Free Water: 84%

    • Micronutrients: Meets or exceeds RDIs in 1500 mL

  • Nepro:

    • Caloric Density: 1.8 kcal/mL

    • Protein: 81 grams/liter

    • Free Water: 73%

    • Fiber: 12.6 grams/liter

    • Low in sodium, potassium, and magnesium (<1 g/L)

    • Micronutrient blend specifically designed for renal failure

Modular Protein Supplements

  • ProSource NoCarb (30mL packet):

    • Protein: 15 grams

    • Calories: 60 kcal

  • ProSource Plus (30mL packet):

    • Protein: 15 grams

    • Calories: 100 kcal

Rate – Initiation & Advancement

  • Feeding Method Selection:

    • Choose either continuous or bolus method and eliminate non-selected option described below:

Continuous Feeding

  • Initiation:

    • Begin tube feeding at ___ mL/hr

    • Advance volume by ___ mL every ___ hours as tolerated up to a goal rate of ___ mL/hr

  • Water Flushes:

    • Administer ____ mL every ____ hours

Bolus Feeding

  • Initiation:

    • Begin tube feeding at ___ (can/mL) during the first scheduled bolus

    • If tolerated, increase to ___ (can/mL) at the next scheduled feeding

    • If tolerated, further increase to ___ (can/mL)

    • If tolerated, advance to daily goal regimen as follows:

    • Include total number of cartons/day, volume, and timing of each bolus, along with required water flushes

Modulars (if applicable)

  • Additions:

    • Add ___ packets of ___ every ___ hours (or specify frequency e.g. QD, BID, etc.)

    • Mix with 30 mL of water and use as a flush via feeding tube

Enteral Nutrition Provision (complete for all orders)

  • Potential EN Regimen at Goal:

    • The enteral nutrition regimen at goal has the potential to provide:

Other Orders

  • Patient Positioning:

    • Elevate the head of the bed 30-45°

  • Residual Checks:

    • Do not check residuals in the absence of other signs of intolerance or when the feeding tube is positioned in the small bowel