Jevity 1.5 Volume and Free Water Calculation for an 84-Year-Old, 68 kg Post-Surgical Patient
For this 84-year-old, 68 kg man two months post-abdominal surgery, administer 1,420 mL of Jevity 1.5 daily (providing 2,130 kcal and 85 g protein) plus 400–500 mL of additional free water, divided into either three boluses of 475 mL each or four boluses of 355 mL each, with water flushes distributed throughout the day.
Nutritional Requirements
Energy Needs
- Target: 25–30 kcal/kg/day for this elderly post-operative patient 1
- Calculation: 68 kg × 25–30 kcal/kg = 1,700–2,040 kcal/day
- Jevity 1.5 provides 1.5 kcal/mL, so 1,420 mL delivers 2,130 kcal/day, meeting the upper target range 1
Protein Requirements
- Target: 1.2–1.6 g/kg/day for post-surgical elderly patients 1
- Calculation: 68 kg × 1.2–1.6 g/kg = 82–109 g protein/day
- Jevity 1.5 provides approximately 6 g protein per 100 mL, so 1,420 mL delivers 85 g protein/day, meeting the lower-middle range 1
Fluid Requirements
- Target: 25–30 mL/kg/day for elderly adults 1
- Calculation: 68 kg × 25–30 mL/kg = 1,700–2,040 mL total fluid/day
- Jevity 1.5 is approximately 85% water, so 1,420 mL formula provides 1,207 mL free water 1
- Additional free water needed: 400–500 mL/day to reach total fluid goal 1
Three-Times-Daily Feeding Schedule
Formula Distribution
- Total daily volume: 1,420 mL Jevity 1.5
- Per feeding: 475 mL (rounded from 473 mL for practical measurement)
- Timing: 08:00,13:00,18:00 2, 1
- Administration time: 30–45 minutes per bolus to prevent bloating and dumping syndrome 2, 1
Free Water Flushes
- Total additional water: 450 mL/day
- Distribution: 150 mL after each feeding (08:00,13:00,18:00)
- Flush technique: Administer slowly over 5–10 minutes after each formula bolus 3
Daily Schedule Example (Three Times Daily)
| Time | Jevity 1.5 Volume | Free Water Flush | Administration Duration |
|---|---|---|---|
| 08:00 | 475 mL | 150 mL | 30–45 min + 5–10 min |
| 13:00 | 475 mL | 150 mL | 30–45 min + 5–10 min |
| 18:00 | 470 mL | 150 mL | 30–45 min + 5–10 min |
| Total | 1,420 mL | 450 mL |
Four-Times-Daily Feeding Schedule
Formula Distribution
- Total daily volume: 1,420 mL Jevity 1.5
- Per feeding: 355 mL
- Timing: 08:00,12:00,16:00,20:00 1
- Administration time: 20–30 minutes per bolus (smaller volumes tolerate faster delivery) 2, 1
Free Water Flushes
- Total additional water: 480 mL/day
- Distribution: 120 mL after each feeding (08:00,12:00,16:00,20:00)
- Flush technique: Administer slowly over 5–10 minutes after each formula bolus 3
Daily Schedule Example (Four Times Daily)
| Time | Jevity 1.5 Volume | Free Water Flush | Administration Duration |
|---|---|---|---|
| 08:00 | 355 mL | 120 mL | 20–30 min + 5–10 min |
| 12:00 | 355 mL | 120 mL | 20–30 min + 5–10 min |
| 16:00 | 355 mL | 120 mL | 20–30 min + 5–10 min |
| 20:00 | 355 mL | 120 mL | 20–30 min + 5–10 min |
| Total | 1,420 mL | 480 mL |
Administration Technique and Safety
Bolus Feeding Method
- Use gravity feeding or slow syringe administration over the recommended time frame 2
- Administer with patient sitting upright or head of bed elevated ≥30° during feeding and for 30 minutes after 1, 3
- Never administer boluses faster than 15 minutes to avoid dumping syndrome, bloating, and post-prandial hypotension in elderly patients 2, 1
Formula Preparation
- Do NOT dilute Jevity 1.5—use full-strength formula 1
- Dilution increases infection risk, creates osmolality problems, and reduces nutrient delivery without clinical benefit 1
- Use commercially prepared formula only; home-blended feeds carry high infection risk and poor micronutrient quality 2, 1
Monitoring Parameters
- Check gastric residual volume before each feeding; hold feeding if residual exceeds 200 mL 1, 3
- Monitor for signs of intolerance: abdominal distension, nausea, vomiting, diarrhea 1, 3
- Weekly assessment: weight, serum albumin, electrolytes (Na⁺, K⁺, Mg²⁺, Ca²⁺, PO₄³⁻) 1, 3
- Post-surgical monitoring: vitamin B₁₂, iron, calcium, vitamin D levels (absorption may be compromised after abdominal surgery) 1
Rationale for Schedule Choice
Three-Times-Daily Advantages
- Larger boluses (475 mL) more closely mimic normal meal patterns 2
- Fewer interruptions to daily activities and improved quality of life 2, 1
- Suitable for patients with good gastric tolerance at two months post-operative 2, 1
Four-Times-Daily Advantages
- Smaller boluses (355 mL) reduce risk of gastric distension and dumping symptoms 2, 1
- Better tolerance in patients with delayed gastric emptying or early satiety 2
- More gradual nutrient delivery may improve absorption in compromised gastrointestinal function 2, 1
Critical Pitfalls to Avoid
- Never rush bolus administration—rapid delivery in elderly patients causes dumping syndrome, hypotension, and aspiration risk 2, 1
- Do not feed overnight if aspiration risk exists—continuous overnight feeding increases aspiration risk in at-risk patients 2
- Avoid inadequate free water supplementation—dehydration is common in elderly tube-fed patients and manifests as fatigue, confusion, and electrolyte imbalance 2, 1
- Do not ignore gastric residuals >200 mL—this indicates intolerance and requires feeding adjustment 1, 3
- Never attribute diarrhea to formula without first evaluating medications (especially antibiotics) and other causes 1