Recommended Amount and Frequency of Ensure for PEG Tube Feedings
For patients with PEG tubes, enteral nutrition should begin with a low flow rate of 10-20 ml/hour and gradually increase over 5-7 days to reach target nutritional requirements, using a standard formula like Ensure. 1
Initial Administration Protocol
Starting the Feeding
- Begin enteral nutrition within 24 hours after PEG placement 1
- Initial flow rate: 10-20 ml/hour 1
- Gradually increase rate based on individual tolerance
- May take 5-7 days to reach target nutritional requirements 1
Progression Schedule
- Day 1: Start at 10-20 ml/hour
- Days 2-7: Gradually increase rate based on tolerance
- Target: Calculate based on patient's caloric needs (typically 25-30 kcal/kg/day)
Formula Selection and Administration
Type of Formula
- Standard whole protein formula (like Ensure) is appropriate for most patients 1
- Avoid kitchen-made/blenderized diets due to:
- Risk of tube clogging
- Inconsistent nutritional content
- Infection risk from contamination 1
Administration Method
- Use a controller pump for continuous feedings to maintain constant rate 2
- Flush feeding tube with water:
- Every 4 hours during continuous feedings
- After intermittent feedings
- After medication administration
- After checking gastric residuals 2
Monitoring Protocol
Regular Assessment
- Check vital signs and fluid intake/output every 8 hours
- Measure weight daily
- Monitor serum electrolytes, BUN, and glucose daily until stable
- Check urine sugar and acetone levels every 6 hours until stable 2
Complication Prevention
- Confirm tube placement before each feeding
- Add food coloring to feedings to help detect aspiration/tube displacement
- Monitor for signs of gastrointestinal intolerance (diarrhea, vomiting, abdominal distension)
- Assess for tube obstruction and maintain patency 2
Long-term Considerations
- PEG is recommended when enteral nutrition is needed for more than 4 weeks 1
- Regularly reassess nutritional status during hospital stay 1
- Continue nutritional support after discharge if oral intake remains inadequate 1
- Encourage any safe oral intake alongside tube feeding when possible 1
Common Pitfalls and Caveats
- Rapid Administration: Too rapid administration can lead to small bowel ischemia with high mortality risk 1
- Tube Clogging: Prevent by regular flushing; if clogged, attempt irrigation with water or cola 2
- Diarrhea: Multiple potential causes including drug therapy, hypoalbuminemia, formula factors (osmolality), and bacterial contamination 2
- Aspiration Risk: Proper positioning and monitoring are essential to prevent aspiration pneumonia
- Delayed Progression: Some patients may take longer than 7 days to reach target intake; this is not harmful 1
By following this structured approach to PEG tube feeding with Ensure or similar standard formulas, you can optimize nutritional support while minimizing complications and improving patient outcomes.