Tube feeding

Tube Feeding Orders

  • Overview of Tube Feeding Orders:

    • Important checkbox options to indicate the initiation of tube feeding (TF) via various feeding tubes:

    • NGT (Nasogastric Tube)

    • OGT (Orogastric Tube)

    • NDT (Naso-Duodenal Tube)

    • PEG (Percutaneous Endoscopic Gastrostomy)

    • Jejunal tube

    • Administration Methods:

    • Continuous

    • Bolus

    • Intermittent

Type of Formula

  • Types of Nutritional Formulas:

    • Osmolite 1.2:

    • 1.2 kcals/mL

    • 55.5 grams of protein per liter

    • 82% free water

    • Meets or exceeds RDIs (Reference Daily Intakes) for micronutrients in 1200 mL

    • Jevity 1.2:

    • 1.2 kcals/mL

    • 55.5 grams of protein per liter

    • 81% free water

    • Meets or exceeds RDIs for micronutrients in 1250 mL

    • Contains 17 grams of fiber per liter

    • Osmolite 1.5:

    • 1.5 kcals/mL

    • 63 grams of protein per liter

    • 76% free water

    • Meets or exceeds RDIs for micronutrients in 1000 mL

    • Jevity 1.5:

    • 1.5 kcals/mL

    • 63.8 grams of protein per liter

    • 76% free water

    • Meets or exceeds RDIs for micronutrients in 1000 mL

    • Pivot 1.5:

    • 1.5 kcals/mL

    • 93.8 grams of protein per liter

    • 75% free water

    • Meets or exceeds RDIs for micronutrients in 1000 mL

    • Glucerna 1.2:

    • 1.2 kcals/mL

    • 60 grams of protein per liter

    • 81% free water

    • Meets or exceeds RDIs for micronutrients in 1250 mL

    • Two Cal HN:

    • 2 kcals/mL

    • 83.5 grams of protein per liter

    • 70% free water

    • Meets or exceeds RDIs for micronutrients in 948 mL

    • Vital AF 1.2:

    • 1.2 kcals/mL

    • 75 grams of protein per liter

    • 81% free water

    • 5 grams of fiber per liter

    • Meets or exceeds RDIs for micronutrients in 1185 mL

    • Vivonex Plus:

    • 1.0 kcals/mL

    • 45 grams of protein per liter

    • 100% free amino acids

    • 6.6 grams of fat per liter

    • 83% free water

    • 0 fiber

    • Meets RDIs for micronutrients in 1800 mL

    • Vital High Protein:

    • 1 kcal/mL

    • 87.3 grams of protein per liter

    • 84% free water

    • Meets or exceeds RDIs in 1500 mL

    • Nepro:

    • 1.8 kcal/mL

    • 81 grams of protein per liter

    • 73% free water

    • 12.6 grams of fiber per liter

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

    • Micronutrient blend designed for renal failure

Modular Protein Supplements

  • Types of Modular Protein Supplements:

    • ProSource NoCarb:

    • 30 mL packet

    • 15 grams of protein

    • 60 kcals

    • ProSource Plus:

    • 30 mL packet

    • 15 grams of protein

    • 100 kcals

Initiation & Advancement of Tube Feeding

  • Continuous Feeding:

    • Initiate of TF at: mL/hr

    • Advance: mL every _ hours as tolerated

    • Goal rate of: _ mL/hr

    • Water flushes with: ____ mL every ____ hours

  • Bolus Feeding:

    • Initiate TF at (can/mL) at first scheduled bolus feeding

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

    • If tolerated, increase to _ (can/mL)

    • If tolerated, advance to daily goal regimen of:

    • Include total number of cartons per day, volume, and time of each bolus

    • Water flushes required

  • Modulars: (delete if not applicable)

    • Add: packets of every hours

    • (Or indicate frequency i.e. QD, BID)

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

Enteral Nutrition (EN) Provision

  • EN regimen at goal has the potential to provide: (Complete for all orders)

Other Orders

  • Additional instructions:

    • Elevate the head of the bed 30-45°

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