How to switch Isosource HN 120 from intermittent to continuous feeding at 180 ml/hr?

Switching Isosource HN 120 from Intermittent to Continuous Feeding at 180 ml/hr

To switch Isosource HN 120 from intermittent to continuous feeding at 180 ml/hr, use an enteral feeding pump to deliver the formula continuously over 24 hours, ensuring proper hydration with 30-50 ml water flushes every 4 hours to prevent tube clogging.

Implementation Process

Step 1: Equipment Preparation

• Obtain an enteral feeding pump and appropriate administration set compatible with your feeding tube
• Ensure the pump is calibrated correctly for the prescribed rate of 180 ml/hr
• Position the patient at 30° or higher elevation to reduce aspiration risk 1

Step 2: Transition Protocol

1. Initial Setup:

   • Connect the feeding tube to the administration set and pump
   • Prime the tubing with formula to remove air
   • Set the pump rate to 180 ml/hr as prescribed

2. Monitoring Schedule:

   • Check gastric residuals every 4 hours during the first 24 hours of continuous feeding
   • If aspirates exceed 200 ml, pause feeding and reassess 1
   • Monitor for signs of feeding intolerance (abdominal distension, nausea, vomiting)

Step 3: Hydration Management

• Flush the feeding tube with 30-50 ml water every 4 hours during continuous feeding 2
• Flush before and after medication administration with 30 ml water
• Calculate total daily fluid requirements (typically 30 ml/kg/day) and ensure adequate hydration 1, 2

Important Considerations

Feeding Tube Care

• Loosen and rotate the gastrostomy tube regularly to prevent blockage through mucosal overgrowth 1
• Keep the patient elevated at 30° or more during feeding and for 30 minutes after any interruption 1
• Ensure proper tube placement verification before initiating continuous feeding 3

Monitoring Parameters

• Monitor vital signs and fluid intake/output every 8 hours
• Check weight daily
• Monitor electrolytes, especially during the first few days of continuous feeding 1, 2
• Watch for signs of refeeding syndrome in malnourished patients 1

Medication Administration

• Administer medications separately from feeds
• Flush the tube before and after medication administration
• Use liquid medications when possible to prevent tube clogging 1, 2

Potential Complications and Management

Tube Obstruction

• If obstruction occurs, attempt to flush with warm water
• Never use excessive force when flushing
• Preventative regular flushing is essential 3

Gastrointestinal Intolerance

• If diarrhea develops, do not automatically assume it's due to continuous feeding method, as evidence shows no significant difference between continuous and intermittent feeding in alleviating diarrhea 4
• Consider medication side effects as a common cause of diarrhea 1
• Consider allowing breaks in feeding of 4-8 hours if persistent diarrhea occurs 1

Infection Prevention

• Change feeding bags and administration sets every 24 hours
• Practice strict hand hygiene when handling formula and equipment
• Avoid gastric acid suppression when possible to prevent bacterial overgrowth 1

By following this protocol, you can safely transition from intermittent to continuous feeding with Isosource HN 120 at 180 ml/hr while minimizing complications and ensuring optimal nutrition delivery.