Tube Feeding

Tube Feeding Orders

Transitioning from Parenteral Nutrition (PN) to Enteral Nutrition (EN)

  • Check the Box: SAMPLE for transitioning PN to EN.

Tube Types for Administration

  • Options:

    • NGT (Nasogastric Tube) / OGT (Orogastric Tube)

    • Duodenal tube

    • PEG (Percutaneous Endoscopic Gastrostomy)

    • Jejunal tube

Administration Methods

  • Types of Administration:

    • Continuous

    • Bolus

    • Intermittent

Types of Formula

  • Osmolite 1.2:

    • kcal/mL: 1.2

    • Protein: 55.5 grams/liter

    • Free Water: 82%

    • Fiber: 0 grams

    • Meets or exceeds RDIs for micronutrients in 1200 mL.

  • Jevity 1.5:

    • kcal/mL: 1.5

    • Protein: 63.8 grams/liter

    • Free Water: 76%

    • Fiber: 5.3 grams/8 oz.

    • Meets or exceeds RDIs for micronutrients in 1000 mL.

  • Glucerna 1.2:

    • kcal/mL: 1.2

    • Protein: 60 grams/liter

    • Free Water: 81%

    • Fiber: 3.8 grams/8 oz.

    • Meets or exceeds RDIs for micronutrients in 1250 mL.

  • Two Cal HN:

    • kcal/mL: 2

    • Protein: 83.5 grams/liter

    • Free Water: 70%

    • Fiber: 0 grams

    • Meets or exceeds RDIs for micronutrients in 948 mL.

  • Oxepa:

    • kcal/mL: 1.5

    • Protein: 62.7 grams/liter

    • Free Water: 78.5%

    • Fiber: 0 grams

    • Meets or exceeds RDIs for micronutrients in 946 mL.

  • Vital 1.2:

    • kcal/mL: 1.2

    • Protein: 75 grams/liter

    • Free Water: 81%

    • Fiber: 0 grams

    • Meets or exceeds RDIs for micronutrients in 1185 mL.

  • Peptamen Bariatric:

    • kcal/mL: 1

    • Protein: 93.2 grams/liter

    • Free Water: 84%

    • Fiber: 0 grams

    • Meets or exceeds RDIs in 1500 mL.

  • Nepro:

    • kcal/mL: 1.8

    • Protein: 81 grams/liter

    • Free Water: 73%

    • Fiber: 3 grams/8 oz.

    • Special Characteristics: Low in sodium, potassium, and magnesium (<1 g/L).

    • Designed for renal failure.

Modular Protein Supplements

  • Procel: 5 grams of protein per packet.

  • Liquacel: 16 grams of protein per packet.

Rate: Initiation & Advancement

  • Initial EN Rate: Start at 30 mL/hour.

  • Decrease PN Rate: From 85 mL/hour to 55 mL/hour.

  • Continue MIV (Medically Necessary Intravenous Fluid): At 35 mL/hour.

  • After 8 hours:

    • Increase EN to 60 mL/hour.

    • Decrease PN to 25 mL/hour.

    • Continue MIV at 35 mL/hour.

  • After another 8 hours:

    • Increase EN to goal rate of 75 mL/hour.

    • Discontinue PN.

    • Increase MIV to 42 mL/hour.

  • Note on Rate Increase: Only increase EN if well tolerated.

Monitoring Plan

  • Residuals Check Frequency: Every 4 hours and before each feeding.

  • Special Cases:

    • Do not check residuals if feeding tube is in the small bowel.

  • Holding Instructions:

    • For residuals > 500 mL (PEG feedings), hold for 2 hours.

    • For residuals > 250 mL (oral or nasogastric feedings), hold for 2 hours.

Additional Considerations

Positioning

  • Head of Bed: Elevated at 30°.

Water Flush

  • Rate: 25 mL/hour.

  • Flush Procedure: Water flush before and after feedings with ____ mL of sterile water.

Additional Notes

  • Other Considerations:

    • _