Common Tube Feeding Orders I have Used. The following two orders were for a patient with a stroke with PMH of HTN (no CHF or renal failure) who had a new PEG tube placed. There weren’t meant to run at the same time. When she couldn’t tolerate bolus feedings, then we did continuous feeding.
–Tube Feeding Bolus (Bolus Tube Feedings). Standard 1.5 cal/ml, Formula: Jevity 1.5, 250ml. Route: Nasogastric / Orogastric Tube / PEG Tube, 5 times / day, (1875 kcals / 90g pro / 950 ml free fluid). 200 ml fluid flush up to 5 times daily as fluid status permits.
-Tube Feedings Continuous. Formula Jevity 1.5, 50ml/hr. Route: Nasogastric / Orogastric / PEG. Hold for residual > 200ml and notify MD.
Note, on continuous tube feeds, I have used rates of 50-60cc/hr on different adult patients in the hospital.
We also give free water of say 300-500cc per day as flushes. May give more depending on hydration status of the patient.
After insertion of a new PEG tube in, we usually wait for 12 hours before using it. Read this article that says we can do it in less time.
The reason for the wait seems to be because of “concerns for leakage into the peritoneal cavity and gastric retention after insertion of the PEG tube, thereby increasing the risk for peritonitis and aspiration, respectively.” Check to see if research supports those fears.
https://www.ncbi.nlm.nih.gov/pubmed/16214975
http://www.practicalgastro.com/pdf/November06/CondronArticle.pdf