Typical Enteral Feed Bolus Amount
A typical enteral feed bolus is 200-400 mL administered over 15-60 minutes at regular intervals (typically 4-6 times daily). 1
Standard Bolus Parameters
The established bolus feeding protocol includes:
- Volume per bolus: 200-400 mL of feed 1
- Administration time: 15-60 minutes per bolus, adjusted based on patient tolerance 1, 2
- Frequency: 4-6 boluses per day to meet nutritional requirements 2
- Administration method: Can be delivered using a 50 mL syringe (with or without plunger) or via gravity feeding 1
Critical Route-Specific Restrictions
Bolus feeding is ONLY appropriate for gastric feeding routes (nasogastric tubes or gastrostomy tubes). 1, 2
Absolute Contraindication
- Never administer bolus feeds into the jejunum - this causes dumping syndrome and requires continuous pump-assisted feeding instead 1, 2
- Post-pyloric (jejunal) feeding necessitates continuous administration due to loss of the stomach reservoir function 1, 3
Practical Administration Guidelines
Technique
- Use a 50 mL syringe for administration 1
- If the plunger is removed, the syringe can be hung to allow gravity feeding 1
- Mandatory flushing: Use at least 30 mL of water before and after each bolus to prevent tube obstruction 2
Advantages of Bolus Feeding
- Greater patient autonomy and mobility compared to continuous feeding 2, 4
- More physiologic feeding pattern when stomach is intact 2, 5
- Lower cost and greater convenience for stable patients 4
- Facilitates daily activities and social life 2
Common Pitfalls and Management
Potential Complications
- Bloating and diarrhea may occur with bolus feeding 1
- If intolerance develops, consider switching to intermittent or continuous feeding rather than stopping nutrition entirely 3, 4
- Gastric residual volumes should be monitored, though high residuals are common (occurring in ~46% of patients) with few clinically significant problems when proper technique is used 6
Special Considerations
- Hypercaloric formulas (1.5-2.0 kcal/mL) should preferably be administered via pump rather than bolus 2
- Start with smaller volumes and gradually increase based on tolerance 2
- For patients at aspiration risk, avoid overnight feeding and extend feeding hours into early evening while patient remains upright 3