From the Guidelines
Trickle feeds refer to a method of continuous enteral nutrition delivery where liquid nutrition is administered at a slow, constant rate through a feeding tube, typically between 10-50 ml per hour, to prevent complications and promote better nutrient absorption. This approach is commonly used for patients who cannot consume food orally but need nutritional support, such as those with swallowing difficulties, unconscious patients, or individuals with certain gastrointestinal disorders. According to the most recent and highest quality study, continuous enteral nutrition administered via an enteral feeding pump is recommended, as it appears to have lower complication rates than bolus delivery 1. The slow administration of trickle feeds helps prevent complications like diarrhea, abdominal distension, and aspiration that can occur with bolus feeding methods. Nutritionally complete formulas are used, containing proteins, carbohydrates, fats, vitamins, and minerals in proportions appropriate for the patient's condition.
Some key points to consider when implementing trickle feeds include:
- The use of an enteral feeding pump to administer the nutrition, as recommended by the ESPEN practical guideline 1
- The importance of slowly increasing the rate of administration to the full prescribed volume to minimize complications
- The need to monitor patients closely for mechanical, metabolic, and infectious complications, which can occur with enteral nutrition
- The potential benefits of trickle feeds in maintaining gut integrity and function, particularly in critically ill patients, as they provide constant nutrition to intestinal cells.
It is also worth noting that, while the 2003 guidelines for enteral feeding in adult hospital patients provide some information on modes of feeding, including bolus, intermittent, and continuous infusion 1, the more recent 2020 ESPEN practical guideline provides stronger evidence and recommendations for the use of continuous enteral nutrition via an enteral feeding pump 1.
From the Research
Definition and Administration of Trickle Feeds
- Trickle feeds, also known as intermittent or bolus feeding, involve the administration of enteral nutrition (EN) over a short period, typically 4-10 minutes, using a syringe or gravity drip 2.
- This method of feeding is often used for medically stable patients with feeding tubes terminating in the stomach, as it is more practical in terms of cost, convenience, and patient mobility 2.
Comparison with Other Feeding Methods
- Trickle feeds can be compared to other methods of EN administration, including continuous, cyclic, and intermittent feeding, which can be used alone or in combination 2.
- Continuous feeding involves hourly administration of EN over 24 hours, while cyclic feeding involves administration of EN over a time period of less than 24 hours, both typically assisted by a feeding pump 2.
Clinical Considerations
- The choice of feeding method depends on various factors, including the patient's condition, nutritional needs, and risk of complications 3, 2.
- Trickle feeds may be beneficial for critically ill patients in terms of muscle protein synthesis and gastrointestinal hormone secretion, although more research is needed to support this practice 2.
- Healthcare providers should carefully assess patients and consider individual factors, such as neurological deficits and previous enteral tube feeding, when determining the best feeding method 4.