What feeds can be given through a Ryles tube?

Feeds That Can Be Given Through a Ryles Tube

Standard polymeric enteral formulas can be safely administered through a Ryles tube, with no specific formulation or substrate modifications required for most patients. 1

Types of Feeds Compatible with Ryles Tube

Standard Formulations

• Polymeric formulas: These contain intact proteins and are the first-line choice for most patients 1
• Semi-elemental/hydrolyzed formulas: Can be used when there are concerns about malabsorption
• Elemental formulas: Contain amino acids rather than intact proteins; useful in severe malabsorption cases

Blenderized/Kitchen-Made Diets

• Generally not recommended for hospital use due to:
  • Nutritional inconsistency
  • Short shelf-life
  • Higher risk of contamination
  • Increased risk of tube clogging 1
• May be considered in home care settings where preparation is for a single patient

Administration Considerations

Flow Rate and Initiation

• Start with a low flow rate (10-20 ml/hour) and increase gradually 2
• Increase feeding rate carefully based on individual tolerance 1
• May take 5-7 days to reach target intake in some patients 1

Bolus Feeding Guidelines

For adults 2:

• 200-400 mL per bolus over 15-60 minutes
• Divided into 4-6 feeds daily

Continuous Feeding

• Recommended for patients with limited tolerance
• Requires use of an enteral feeding pump 1
• Allows for better utilization of functional intestinal capacity

Technical Considerations

Tube Management

• Flush tube with 30-50 ml water every 4 hours during continuous feeding 2
• Before medication: Flush with 30 ml water
• After medication: Flush with 30 ml water
• After each feed: Flush with 30-50 ml water

Preventing Tube Clogging

• Use liquid medications when possible 2
• Administer medications separately from feeds
• Flush tube before and after medication administration
• Avoid high-viscosity feeds without proper dilution 3

Patient Positioning

• Position patient at 30° or higher elevation during feeding and for 30 minutes after to reduce aspiration risk 2
• Maintain upright position for 30 minutes after water administration

Special Clinical Situations

Inflammatory Bowel Disease

• Standard enteral nutrition (polymeric, moderate fat content) can be used for primary and supportive nutritional therapy 1
• No need for specific formulations or substrates (e.g., glutamine, omega-3-fatty acids) 1

Acute Pancreatitis

• In severe necrotizing pancreatitis, enteral nutrition is indicated when possible 1
• Peptide-based formulas can be safely used 1
• Standard formulas can be tried if tolerated 1

Post-Surgical Patients

• Early enteral tube feeding after major gastrointestinal surgery reduces infections and shortens length of stay 1
• Should be considered within 1-2 days of surgery in severely malnourished patients 1

Pediatric Patients

Bolus feeding volumes 2:

• 0-1 year: 60-80 mL every 4 hours or 10-15 mL/kg/feed
• 1-6 years: 80-120 mL every 4 hours or 5-10 mL/kg/feed
• 6-14 years: 120-160 mL every 4 hours or 3-5 mL/kg/feed

• 14 years: 200 mL every 4 hours or 3 mL/kg/feed

Common Pitfalls and Complications

Tube-Related Issues

• True knots in Ryles tubes are rare but can occur 4
• Folds and kinks may develop during placement
• Risk of inadvertent entry into trachea, cranial cavity, or intravascular penetration during blind insertion 4

Feed-Related Issues

• Diarrhea occurs in approximately 30% of tube-fed patients 5
  • Antibiotic use is strongly associated with diarrhea during tube feeding
  • Consider allowing breaks in feeding of 4-8 hours if persistent diarrhea occurs 2
• Feeds containing casein (e.g., Complan, Nutrauxil, Fortison, Triosorbon) may curdle in the presence of acid, hindering aspiration 3
• Batch-to-batch variations in liquid feeds can occasionally cause delivery problems 3

Viscosity Considerations

• Feed viscosity decreases at body temperature (37°C) compared to room temperature (24°C) 3
• High-protein feeds (e.g., Clinifeed 500) may require pumping due to higher viscosity 3

Remember that the choice of feed should prioritize the patient's nutritional requirements while considering the practical aspects of administration through a Ryles tube.