What daily volume of Jevity 1.5 should be administered via gastrostomy tube to an 84‑year‑old male, two months post‑operative from oral squamous cell carcinoma, who is NPO?

Daily Jevity 1.5 Volume for Post-Operative Oral Cancer Patient

For an 84-year-old male who is 2 months post-operative from oral squamous cell carcinoma surgery and NPO, administer approximately 1,000-1,250 mL of Jevity 1.5 daily via gastrostomy tube, which provides 1,500-1,875 kcal and 94-117 g protein. This volume is calculated using the standard energy target of 30 kcal/kg/day and protein target of 1.2-1.5 g/kg/day for an estimated body weight of 50-60 kg (typical for an elderly male of this age). 1, 2

Calculation Framework

Energy Requirements

• Target 30 kcal/kg/day as the guiding value for energy intake in older persons, which should be individually adjusted based on nutritional status, physical activity level, disease status, and tolerance. 1
• For a 50 kg patient: 30 kcal × 50 kg = 1,500 kcal/day = 1,000 mL of Jevity 1.5
• For a 60 kg patient: 30 kcal × 60 kg = 1,800 kcal/day = 1,200 mL of Jevity 1.5
• Jevity 1.5 provides 1.5 kcal/mL, making volume calculations straightforward. 1

Protein Requirements

• Target 1.2-1.5 g protein/kg/day for older adults with acute or chronic illness, which includes post-operative cancer patients. 1, 2, 3
• For a 50 kg patient: 1.2-1.5 g × 50 kg = 60-75 g protein/day
• For a 60 kg patient: 1.2-1.5 g × 60 kg = 72-90 g protein/day
• Jevity 1.5 provides 93.8 g protein per liter (9.4 g per 100 mL), meeting these requirements at the calculated volumes. 2

Clinical Context for Head and Neck Cancer

Post-Operative Nutritional Considerations

• Energy and protein intake should remain elevated post-treatment to maintain weight, with monitoring and adjustment as appropriate for head and neck cancer patients. 1
• Energy and protein intake of at least 125 kJ/kg/day (approximately 30 kcal/kg/day) and 1.2 g protein/kg/day is recommended for individuals receiving radiotherapy or chemotherapy, and these elevated requirements should continue post-treatment. 1
• Weekly dietitian contact during active treatment and for 3 months post-treatment is recommended to improve and maintain nutritional status and quality of life. 1

Tube Feeding Specific Guidance

• Fiber-containing products should be used for enteral nutrition in older persons, which Jevity 1.5 provides. 1
• Patients who are unable to eat and reliant on tube feeding should be screened for distress and provided with psychosocial support to assist with quality of life. 1
• At 2 months post-operative, this patient is in the critical window where nutrition intervention for 3 months post-treatment is recommended to improve and maintain nutritional status and quality of life. 1

Administration Protocol

Delivery Method

• Continuous pump feeding can reduce gastrointestinal discomfort and may maximize nutrition support when absorptive capacity is diminished, though intermittent infusion should be initiated as soon as tolerated. 1
• Gastric feeding (via G-tube) permits the use of hypertonic feeds, higher feeding rates, and bolus feeding compared to jejunal feeding. 1
• Patients should be fed propped up by 30° or more and kept propped up for 30 minutes after feeding to minimize aspiration risk. 1

Monitoring Requirements

• Close monitoring of body weight (adjusted for fluid status) is essential to assess whether intake is meeting needs, with adjustments made accordingly. 1, 3
• In patients with doubtful gastrointestinal motility, the stomach should be aspirated every four hours; if aspirates exceed 200 mL, feeding policy should be reviewed. 1
• Regular evaluation of nutritional intake, weight change, and BMI should be repeated depending on the clinical situation. 1

Critical Adjustments and Pitfalls

Renal Function Considerations

• If eGFR < 30 mL/min/1.73 m² and not on dialysis, reduce protein to 0.8 g/kg/day to avoid worsening renal function, which would require switching to a lower-protein formula or reducing volume. 2
• Patients with moderate kidney dysfunction (eGFR 30-59 mL/min/1.73 m²) can safely receive the standard 1.2-1.5 g/kg/day protein target. 2

Fluid Requirements

• Older men should be offered at least 2.0 L of drinks each day unless there is a clinical condition requiring a different approach. 1
• At 1,000-1,250 mL of Jevity 1.5, additional free water flushes totaling 750-1,000 mL should be administered through the G-tube to meet total fluid needs of approximately 2,000 mL/day. 1

Common Errors to Avoid

• Do not use the standard 0.8 g/kg/day protein recommendation, as this represents only the minimum to prevent progressive lean body mass loss in healthy individuals, not optimal repletion for post-operative cancer patients. 2, 4
• Avoid using ideal body weight for calculations; use actual body weight unless working with a dietitian for obese patients. 2, 4
• Do not initiate starter regimens with diluted feeds, as this is unnecessary in patients who have had reasonable nutritional intake and risks infection and osmolality difficulties. 1
• Starter regimens using reduced initial feed volumes are unnecessary in patients who have had reasonable nutritional intake in the last week. 1

Tolerance and Complications

• Gastrointestinal tolerance should be monitored closely; fiber-containing feeds like Jevity 1.5 may help with diarrhea, as will breaks in feeding of 4-8 hours. 1
• Any drugs administered via the G-tube should be liquid and given separately from the feed with flushing of the tube before and after. 1
• Loosening and rotating the gastrostomy tube may prevent blockage through mucosal overgrowth and reduce peristomal infections. 1

Weight Loss Expectations

• More than 10% weight loss warrants nutrition counseling and referral to a nutritionist/dietitian to assess need for extra support. 1
• After major upper gastrointestinal cancer surgery, weight loss of 5-12% at six months postoperatively is common, with more than half of patients losing >10% of body weight at 12 months. 1
• Better weight, muscle, and fat store preservation has been demonstrated with home enteral feeding by gastrostomy tube in post-operative patients. 1