For an 84‑year‑old male weighing 68 kg with a gastrostomy tube receiving Jevity (1.5 kcal/mL), how much volume can be administered via syringe in a 10‑minute bolus?

Bolus Administration of Jevity via Gastrostomy Tube

For an 84-year-old male receiving Jevity 1.5 through a gastrostomy tube, administer 200–400 mL per bolus over 15–60 minutes using a 50 mL syringe, which means in a 10-minute period you can safely give approximately 130–270 mL depending on tolerance. 1

Standard Bolus Administration Protocol

The ESPEN guidelines specify that bolus feeding through a gastrostomy tube should follow these parameters:

• Volume per bolus: 200–400 mL of formula 1
• Administration time: 15–60 minutes per bolus 1
• Delivery method: 50 mL syringe with or without plunger 1

Calculating the 10-Minute Volume

Using the guideline parameters, the rate of administration ranges from:

• Minimum rate: 200 mL ÷ 60 minutes = 3.3 mL/minute → 33 mL in 10 minutes
• Typical rate: 300 mL ÷ 30 minutes = 10 mL/minute → 100 mL in 10 minutes
• Maximum rate: 400 mL ÷ 15 minutes = 26.7 mL/minute → 267 mL in 10 minutes

Therefore, in a 10-minute period, you can administer approximately 100–270 mL of Jevity, with 150–200 mL being a reasonable middle ground for most patients. 1

Critical Safety Considerations

Gastrostomy vs. Jejunostomy Distinction

• Gastrostomy tubes (which this patient has) tolerate bolus feeding well because the stomach serves as a reservoir 1
• Jejunal tubes require pump-assisted feeding and cannot tolerate bolus administration 1, 2
• This distinction is crucial—never attempt rapid bolus feeding through a jejunal tube 2

Syringe Technique

• Use a 50 mL syringe as recommended by guidelines 1
• Smaller syringes (1–5 mL) are more accurate for small volumes but impractical for enteral feeding 3
• The plunger may be removed to allow gravity-assisted flow, or gentle pressure applied to control rate 1
• Never force the syringe—resistance indicates potential tube obstruction 2

Practical Administration Algorithm

Step-by-Step Protocol

1. Pre-feeding flush: Flush tube with 30–50 mL water to confirm patency 1, 2

2. Position patient: Elevate head of bed 30–45 degrees to prevent aspiration 1

3. Initial bolus (first 10 minutes):

   • Start with 100–150 mL for the first 10-minute segment
   • Observe for tolerance (no abdominal distension, nausea, or discomfort)
   • For a 68 kg patient receiving Jevity 1.5, this provides approximately 150–225 kcal 1

4. Subsequent administration:

   • Continue at same rate for additional 5–20 minutes to complete the 200–400 mL bolus
   • Total bolus time should be 15–30 minutes for most patients 1

5. Post-feeding flush: Flush with 30–50 mL water immediately after completion 1, 2

6. Frequency: Divide total daily volume into 4–6 boluses throughout the day 1

Common Pitfalls and How to Avoid Them

Tolerance Issues

• If patient develops nausea or bloating: Reduce rate to 200 mL over 30–60 minutes (approximately 65–100 mL per 10 minutes) 1
• Monitor for dumping syndrome: Rapid gastric emptying can cause cramping, diarrhea, and hypotension—slow the rate if this occurs 2

Tube Maintenance

• Flush before AND after each feeding to prevent tube occlusion 1, 2
• Check tube patency every 4 hours if continuous feeding, or before each bolus 1
• Never use carbonated drinks or acidic juices for flushing—these degrade tube material 2

Medication Administration

• If medications need to be given through the tube, pause feeding, flush, give medication, flush again, then resume 2
• Separate medication administration from feeding by at least 15–30 minutes when possible 2

Monitoring Requirements

• Check residual volume before each bolus (though this practice is controversial and not universally recommended) 1
• Observe for signs of intolerance: abdominal distension, pain, nausea, vomiting, or diarrhea 2
• Maintain head elevation for 30–60 minutes after feeding to prevent aspiration 1

High-Calorie Formula Considerations

Since Jevity 1.5 is a high-calorie formula (1.5 kcal/mL):

• Smaller volumes deliver adequate calories: 200 mL provides 300 kcal 1
• May require slower administration than standard 1.0 kcal/mL formulas to prevent osmotic diarrhea 1
• Preferentially use pump-assisted feeding for high-calorie formulas when possible, though bolus is acceptable for gastrostomy tubes 1