How much free water to put in G-tube?

Nurses General Nursing

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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.

Specializes in Complex pedi to LTC/SA & now a manager.
smartnurse1982 said:
What is wrong with replacing soda with water?

It's not replacing soda with water but replacing water with the empty calories & sugar of soda. Plus the soda reacts with the formula.

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JustBeachyNurse said:
It's not replacing soda with water but replacing water with the empty calories & sugar of soda. Plus the soda reacts with the formula.

When I worked ltc we used to have these convos all the time.

I used to say as long as it is not contraindicated let them drink it(like iced TEAS,Pepsi,etc)

fluid that they are actually going to drink is better than some fluid that they really will not drink(plain water).

Other nurses used to lecture pts on drinking so much soda and iced TEAS.

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Specializes in Complex pedi to LTC/SA & now a manager.

Now it's contraindicated, especially with high protein formulas as the formula curdles and clogs the tube when mixed with soda. Precipitated form in the tubing even if only a trace of formula which narrows and clogs the tube slowly.

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smartnurse1982 said:
When I worked ltc we used to have these convos all the time.

I used to say as long as it is not contraindicated let them drink it(like iced TEAS,Pepsi,etc)

fluid that they are actually going to drink is better than some fluid that they really will not drink(plain water).

Other nurses used to lecture pts on drinking so much soda and iced TEAS.

I tend to agree with you regarding PO fluids. The elderly are prone to dehydration and if they aren't going to meet fluid requirements drinking plain water then let them drink whatever. However we are talking about someone putting cola into a G tube, essentially dumping it straight into the stomach. There's no benefit to this as the patient isn't even tasting it. The formula contains all the required nutritional elements and since the patient gets no pleasure from the cola, juice, or whatever there's no point to use anything but formula and water flushes.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

My patient gets 960mL of formula (960 calories, 85% water) and 960mL of water per day.

He weighs 53kg, and his weight has been stable for over a year. His urine is clear-to-light yellow.

I can't even imagine how many times a day I'd be changing his bedding if his free water was upped to 20 ounces (590mL) four times a day... he can already pee like a racehorse at his current levels!

Also, keep in mind that the nutritional requirements for a bedbound person are NOT the same as for a healthy walkie-talkie.

If the weight is stable and the urine is not concentrated and the lungs are clear and the flesh isn't edamatous, I wouldn't be too concerned. But if you want to change fewer diapers (and bed linens), you might want to get the amount of water reduced.

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Specializes in Pedi.
smartnurse1982 said:
When I worked ltc we used to have these convos all the time.

I used to say as long as it is not contraindicated let them drink it(like iced TEAS,Pepsi,etc)

fluid that they are actually going to drink is better than some fluid that they really will not drink(plain water).

Other nurses used to lecture pts on drinking so much soda and iced TEAS.

Well but we're not talking about someone drinking soda, we're talking about it being administered via GT in place of water. Surely you can see the difference.

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I wonder if she thinks he enjoys the soda pop...How could he if it bypasses the taste buds?

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Specializes in Complex pedi to LTC/SA & now a manager.

Maybe likes the bubbles in the belly ;)

Seriously maybe before he became ill he liked soda so the wife continues to do so because no one explained that he can't taste it nor is it a good idea to run soda in a GT due to risk of erosion and precipitation.

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KelRN215 said:
Well but we're not talking about someone drinking soda, we're talking about it being administered via GT in place of water. Surely you can see the difference.

Sure I do.

But as you guys said on another post that I made,the family can give pts whatever they want.

Well,the wife may be clogging the tube,but its a big maybe.

Maybe as pointed out above he likes to burp up the soda bubbles?

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"Maybe as pointed out above he likes to burp up the soda bubbles?"

Or the sugar rush afterwards...

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I've been researching this, too. I've found that Institute of Medicine (IOM) has new recommendations. Healthy men should have 3.7 liters fluid per day; healthy women should have 2.7 liters per day. Dietary recommendations often suggest the 30 - 35 mL/kg/day. It is common to deduct the free water (usually 80 - 85% of total liquid) in tube feeding formulas.

My patient in home care is recommended to receive 1200 mL free water in addition to 1080 mL provided in her tube feeding. She has been getting 3600mL free water -- or more -- per 24 hours. Her urine output has been 3000 or more, and stool output via ileostomy has been 800 mL or more. I am concerned about overhydration or overworking her kidneys if that is possible.

Any comments welcome.

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