Enteral Feed Rates

[TheRuskie]

I work in a PICU and we often feed through either NG, ND or NJ tubes. I was told that there is a very dangerous issue feeding too fast through an ND or NJ d/t potential for causing trauma to the Duodenum or Jejunum. I have been unable to find anything sensible online and wondered if anyone had research on acceptable rates for Bolus, Continual or Gavage feed rates through ND and NJ tubes.

[jennylee321]

That's a good question, I don't know exact rate because I imagine it would depend on age of the child, but I do know that those with Duodenal or jejunal tubes are meant to be on continuous feeds, never bolus.

[TheRuskie]

Do you have anything evidence based? It might help me track down real feed rates etc. or at least find something that evidences never bolus'ing ND/NJ. A continuous is essentially a bolus but over a longer/acceptable period.

[KelRN215, BSN, RN]

That's a good question, I don't know exact rate because I imagine it would depend on age of the child, but I do know that those with Duodenal or jejunal tubes are meant to be on continuous feeds, never bolus.

I've been a pediatric nurse for 10 years and this has always been what I've known too. You can't bolus into the intestines, only the stomach.

Rates would depend on the age/size of the child. There are older/adult sized children who are on continuous feeds via J at 100 mL/hr or more but a baby's rate could be 20 mL/hr.

[TheRuskie]

I'm in the PICU so we get anything from 6 months to 22 years but let's say I get an order for a 6 month old for continuous who has an ND tube at 24 cc/hour - How would I know if that was safe - What if I am told to Bolus 24 cc over one hour - That is the same as the continual rate so where can I verify safety? It is easy to say never bolus the intestines but really it is a question of how much can we feed the intestines over what time period - Seems like there should be a table of rates by tube placement (ND/NJ) and age?

[Susie2310]

I don't work in pediatrics but my suggestion would be to see if the current AACN Pediatric Critical Care Core Curriculum contains this information.

[Julius Seizure]

Essentially, the intestine isn't physiologically meant to have a large amount of food all at once - it doesnt distend like the stomach can. Since a bolus feed is usually 3-6x the amount of what a continuous hourly rate would be, you can see the problem. But lets say you were just going to give the hourly rate for ONE hour and then stop. Technically that's a bolus, I suppose. In complex/chronic patients, I've occasionally had to give enough meds through a GJ at once that it nearly equals the hourly rate if they were receiving continuous feeds. The problem isn't so much the starting and stopping as it is the large volume all at once. But you will never get enough food into them without either giving a low continuous rate or large boluses. There is no "magic number" for a safe rate, and some kids get "continuous" feeds over 20 hours, with a 4 hour break. The goal is just to avoid large volumes. If they start having symptoms of dumping syndrome (see below), then you know its probably too much.

I've included a link with info about post-pyloric feedings. The quote can be found just past the mid-way point on the page that I have linked to.

Post-pyloric feeding

" The ability of the stomach to distend and contain a large amount of food all at once is a great advantage compared to the limited distension capability of the jejunum. Some patients who are fed postpylorically may develop symptoms similar to dumping syndrome, i.e. faintness, palpitations, sweating, tachycardia, rebound hypoglycemia, and diarrhea. Therefore, intrajejunal feeding should always be carried out continuously by pump and not by boluses."