How much free water to put in G-tube?

[JerseyCCRN]

How much water does a patient need per day to meet hydration requirements if they are strictly fed via G-tube? I have a patient who receives 4 20 ounce water bottles per day, 4 cans of Jevity 1.2 cal (237 ml) 8 oz can. I want to make sure this is meeting his nutritional needs.

Background, patient is 75 y/o man, no history of kidney/liver issues. G-tube due to aspiration and swallow issues. Patient is a quad, wife cares for G-tube. She stated she sometimes gives soda pop via tube in place of water. No fluids/foods by mouth, strictly G-tube nutrition.

I researched this to no avail, dietician with my agency are not available until next Tuesday. PCP not giving me the time of day. I want to make sure this patient is receiving what they need. This regimen is ordered by MD. Currently tube has brown residue that looks like mold, PCP saw patient Friday and said it was a non-issue. This very well meet all requirements, I am just not too familiar with G-tube protocol.

Thanks!

PS not asking you to give me advice to treat this patient. I will likely not see this patient again, as I do not typically work weekends, I was just filling in for a call out.

[caliotter3]

Work in extended care home health where water requirements are usually addressed on the plan of care. I would keep trying to get an order.

[MunoRN, RN]

The 'standard' recommendation ranges typically between 25 and 35 ml/kg/day of water. Standard tube feeding formulas, such as promote, are 80-85% water. So your patient is getting about 780 ml/day of water in the promote. The additional 80 ml would bring it up to 960 ml of water/day which would be less than the recommended amount for the typical patient.

The "brown residue" might actually be a result of flushing with soda pop. Cola used to be considered an effective way of unclogging feeding tubes, although with modern high protein tube feeding formulas cola actually causes a precipitate (the acidity denatures proteins) and will leave a residue adhered to the inner wall of the tube.

[kiszi, RN]

MunoRN, the OP stated the pt was getting an additional 80 ounces of free water, not cc. So that comes out to a whopping 2400cc of free water flushes. Way more than enough.

[Clovery]

Sounds like more than enough water. I would be checking labs for hyponatremia. The amount of Jevity may or may not be meeting nutritional needs. It depends on the patient's current size/weight. The patient is a quad... does he have wounds? If so a protein supplement may be needed. Where I work an average sized man will typically get around 60 mL formula per hour with 30 mL water flush hourly. That's a little more formula and a lot less water than your guy is getting.

[KelRN215, BSN, RN]

How much does this guy weigh? Fluid requirements are officially based on weight but your average (healthy) adult needs roughly 2L of fluid per day. (Remember the old adage of 8 (eight ounce) glasses of water per day? That's roughly 2L.) Your patient is getting a LOT of fluid. He's getting 2400 mL of straight water in addition to the fluid in the Jevity.

He may not, however, be getting enough CALORIES per day. If he gets roughly 960 mL of Jevity 1.2 that's only 1150 calories.

[MunoRN, RN]

kiszi said:

MunoRN, the OP stated the pt was getting an additional 80 ounces of free water, not cc. So that comes out to a whopping 2400cc of free water flushes. Way more than enough.

My bad. Yes, that's plenty.

[nurseprnRN, BSN, RN]

Everyone like this should have a nutritionist assessment at least quarterly until stable, then 1-2x/year at a minimum. More often if developing or not healing wounds, weight loss, or other evident need. Nutrition assessment should include labs, esp prealbumin and albumin, testosterone levels (needed for wound healing and general tissue maintenance), vitamin levels (ditto), and general chemistries.

Perhaps if the physician thinks everything is hunky-dory, s/he could confirm it with normal findings. But I'm betting not.

[ArtClassRN, ADN, RN]

2400 ml free water per day not counting flushes? Whoo!

[Carrie RN]

You do need a weight. Also because medicare/medicaid is involved you need the RD to get in there soon. Tuesday doesn't seem very soon. Why is the wife giving him soda pop via tube. Is this like another poster mentioned that the tube is getting clogged? Otherwise to replace water with soda is not a good idea. I am going to agree as well with KelRN.

[amoLucia]

Soda could also make him gassy and prone to belching(?). You state there's aspiration & swallowing issues.

[smartnurse1982]

Carrie RN said:

Why is the wife giving him soda pop via tube? Is this like another poster mentioned that the tube is getting clogged? Otherwise to replace water with soda is not a good idea. .

What is wrong with replacing water with soda,esp if he has no kidney and diabetes issues?

Maybe she could give him apple juice instead via gt.