nutritional disorders
Enteral Tube Nutrition
Administration
 during tube feeding and for 1 to 2 hours afterward to minimize incidence of nosocomial Aspiration Pneumonitis and Pneumonia and to allow gravity to help propel the food. Tube feedings are given in boluses several times a day or by continuous infusion. Bolus feeding is more physiologic and may be preferred for patients with diabetes. Continuous infusion is necessary if boluses cause nausea. For bolus feeding, total daily volume is divided into 4 to 6 separate feedings, which are injected through the tube with a syringe or infused by gravity from an elevated bag. After feedings, the tube is flushed with water to prevent clogging. Nasogastric, gastrostomy, or nasoduodenal tube feedingoften causes diarrhea initially; thus, feedings are usually started with small amounts of dilute preparations and increased as tolerated. Most formulas contain 0.5, 1, or 2 kcal/mL. Formulas with higher caloric concentration (less water per calorie) may cause decreased gastric emptying and thus higher gastric residuals than when more dilute formulas with the same number of calories are used. Initially, a 1-kcal/mL commercially prepared solution may be given undiluted at 50 mL/hour or, if patients have not been fed for a while, at 25 mL/hour. Usually, these solutions do not supply enough water, particularly if vomiting, diarrhea, sweating, or fever has increased water loss. Extra water is supplied as boluses via the feeding tube or IV. After a few days, the rate or concentration can be increased as needed to meet caloric and water needs. Jejunostomy tube feedingrequires greater dilution and smaller volumes. Feeding usually begins at a concentration of≤0.5 kcal/mL and a rate of 25 mL/hour. After a few days, concentrations and volumes can be increased to eventually meet caloric and water needs. Usually, the maximum that can be tolerated is 0.8 kcal/mL at 125 mL/hour, providing 2400 kcal/day. 