G-Tube Feeding Prescription for an 84-Year-Old Male at 2 Months Post-Op
Daily Jevity 1.5 Volume: 1,200–1,500 mL
For this 68 kg (150 lb) patient who is 2 months post-operative and tolerating G-tube feeds, provide 1,200–1,500 mL of Jevity 1.5 daily via bolus feeding, delivering 1,800–2,250 kcal and 75–94 grams of protein, with an additional 400–500 mL of free water flushes to meet total fluid requirements.
Caloric and Protein Targets
- Energy requirement: 25–30 kcal/kg/day based on actual body weight equals 1,700–2,040 kcal/day for this 68 kg patient 1
- Protein requirement: 1.0–1.5 g/kg/day equals 68–102 grams/day 1
- Jevity 1.5 provides 1.5 kcal/mL and approximately 0.063 g protein/mL (6.3 g per 100 mL)
- 1,200 mL of Jevity 1.5 delivers 1,800 kcal and 75 g protein (meets lower targets) 1
- 1,500 mL of Jevity 1.5 delivers 2,250 kcal and 94 g protein (meets higher targets for post-surgical recovery) 1
Feeding Administration Method
Bolus feeding is strongly preferred at 2 months post-op because:
- Continuous feeding is intended for acute phases; at 2 months post-surgery, the patient should transition to bolus delivery to improve mobility and quality of life 2, 1
- Divide total daily volume into 4–6 feedings of 200–375 mL each, administered over 15–60 minutes 3, 2
- Example schedule for 1,500 mL/day: 250 mL at 8 AM, 12 PM, 4 PM, 8 PM, and 250 mL at bedtime (5 feedings) 3
- Maintain head-of-bed elevation ≥30° during feeding and for 30 minutes after to minimize aspiration risk 1
Fluid Management
Total Daily Fluid Requirement
- Approximately 1,800–2,100 mL/day (25–30 mL/kg for elderly patients) 1
Water Content from Jevity 1.5
- Jevity 1.5 is approximately 85% water 1
- 1,200 mL of Jevity 1.5 provides roughly 1,020 mL of free water 1
- 1,500 mL of Jevity 1.5 provides roughly 1,275 mL of free water 1
Ice Chips Contribution
- 60 mL × 5 times daily = 300 mL/day from ice chips (already accounted for in patient's intake)
Additional Free Water Flushes Required
- If giving 1,200 mL Jevity: 1,020 mL (from formula) + 300 mL (ice chips) = 1,320 mL; need 480–780 mL additional water flushes
- If giving 1,500 mL Jevity: 1,275 mL (from formula) + 300 mL (ice chips) = 1,575 mL; need 225–525 mL additional water flushes
- Practical recommendation: Provide 400–500 mL of free water flushes daily (100 mL after each of 4–5 bolus feedings) 2, 1
Safety Monitoring
Before Each Feeding
- Check gastric residual volume: Hold feeding if >200 mL and reassess tolerance 2, 1
- Assess for abdominal distension, nausea, vomiting, or diarrhea before advancing or continuing feeds 2, 1
Ongoing Surveillance
- Monitor electrolytes (Na⁺, K⁺, Mg²⁺, Ca²⁺, PO₄³⁻) during any feeding regimen changes, though refeeding syndrome risk is lower at 2 months post-op 2, 1
- Weekly weight and albumin checks to ensure adequate nutritional repletion 1
Critical Safety Points
- Do NOT dilute Jevity 1.5: Full-strength formula is safe at 2 months post-op and dilution increases infection risk without clinical benefit 1, 3
- Flush the G-tube with 30–50 mL water after each bolus feeding to maintain tube patency 2
- Avoid home-blended feeds: They carry higher contamination risk, cause tube clogging, and lack standardized nutrient composition 1
Practical Example Regimen
| Time | Jevity 1.5 Volume | Water Flush | Notes |
|---|---|---|---|
| 8 AM | 300 mL | 100 mL | Over 30 minutes |
| 12 PM | 300 mL | 100 mL | Over 30 minutes |
| 4 PM | 300 mL | 100 mL | Over 30 minutes |
| 8 PM | 300 mL | 100 mL | Over 30 minutes |
| Bedtime | 300 mL | 100 mL | Over 30 minutes |
| Total | 1,500 mL | 500 mL | Plus 300 mL ice chips = 2,300 mL total fluid |
This delivers 2,250 kcal, 94 g protein, and meets fluid goals 1, 2
Common Pitfalls to Avoid
- Do not continue continuous feeding at 2 months post-op: Transition to bolus improves patient autonomy and is physiologically appropriate for gastric feeding 3, 2
- Do not under-hydrate: Elderly patients have reduced thirst sensation; free water flushes are essential to prevent dehydration 1
- Do not attribute diarrhea to formula first: Evaluate medications (especially antibiotics) and other causes before changing the feeding regimen 1