From the Guidelines
Standard starting feeding tube orders should begin with a low flow rate of 10-20 mL/h and increase carefully due to limited intestinal tolerance, as recommended by the most recent ESPEN guideline 1. When initiating tube feeding, it is essential to consider the patient's individual tolerance and caloric needs.
- The initial flow rate should be low, such as 10-20 mL/h, and increased gradually every 4-8 hours as tolerated.
- The goal rate is usually 50-100 mL/hour, depending on the patient's caloric needs, and may take five to seven days to reach 1.
- Additional orders should include elevating the head of the bed to at least 30 degrees to reduce aspiration risk, checking gastric residual volumes every 4 hours initially, and daily monitoring of input/output and abdominal distention and bowel sounds.
- Medication orders may include a prokinetic agent, proton pump inhibitor, and bowel regimen to prevent constipation and stress ulcer prophylaxis.
- Laboratory monitoring should include daily electrolytes, glucose, and BUN/creatinine initially, then less frequently once stable, to minimize complications like aspiration pneumonia, tube feeding intolerance, and electrolyte imbalances. The most recent ESPEN guideline 1 provides the best evidence for starting feeding tube orders, and its recommendations should be followed to ensure optimal patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Standard Starting Feeding Tube Orders
- The standard starting feeding tube orders may vary depending on the patient's condition and the healthcare facility's protocols 2, 3, 4, 5, 6.
- However, some studies suggest that the use of prokinetic agents such as metoclopramide or erythromycin may be beneficial in facilitating post-pyloric feeding tube placement and improving enteral nutrition tolerance 2, 3, 4, 6.
- Metoclopramide has been shown to be ineffective in facilitating post-pyloric intubation in some studies 2, while others have found it to be beneficial in critically ill children 4.
- Erythromycin has been found to be effective in improving enteral nutrition tolerance and increasing the successful rate of postpyloric EN tube placement 6.
- The role of registered dietitians in nasoenteric feeding tube placement is also being explored, with some studies suggesting that they can play a key role in this process 5.
Key Considerations
- The choice of prokinetic agent and the dosage used may vary depending on the patient's condition and the healthcare facility's protocols 2, 3, 4, 6.
- The use of prokinetic agents should be carefully considered and monitored due to the potential for adverse reactions 2, 6.
- The success rate of post-pyloric feeding tube placement may be influenced by factors such as the patient's condition, the type of feeding tube used, and the experience of the healthcare provider 3, 4.