Question for those who do frequent tube feedings

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I took care of my first patient the other night with a peg tube. He was admitted from a longterm care facility and the order was put into his med reconciliation the same way the order was written at his facility. The doctor chose to continue the tube feeding with the order written the same way his facility had it.

It was written like this: Jevity 1.2 @ 75cc/hr at all times with 30cc free h2o. How fast would you run the flush with an order written like this?

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Specializes in Infection prevention and control.

It was written like this: Jevity 1.2 @ 75cc/hr at all times with 30cc free h2o. How fast would you run the flush with an order written like this?

That order appears to be missing some components...first, are you running it in off a pump with a water bag?? That is the only way this order will work. It should read something like 75 cc/hr ATC with 30 cc/hr free H20. The pump with the water bag allow you to set the rate and time, for instance water flush would be set at 30 cc/q hr so every hour the feeding will shut off and allow the 30 cc of water to run. Does that make sense?

If you don't have a water bag with the pump you use, you need to clarify the order with a flush q shift run in by gravity i.e. Jevity 1.2 75/cc hr ATC, flush H2O 240 cc q shift (30 cc/hr x8 hours) or something like that.

Hope this helps!

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Specializes in Trauma Surgical ICU.

In my facility that is a automatic continuous flush.. The machine has a port for the feeding and one for the water that then leads to a single line to the pts peg... Each hour the line is flushed with 25cc water.. My last hospital did not have feeding pumps like that so we flushed them q4h with a minimum of 30cc water..

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Yeah the pump has a water bag - it's one of those kangaroo pumps that alternates the water with the feeding. Anyhoo.. with the order given the pump was set to flush 30cc/hr water.

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Specializes in Geriatrics and Quality Improvement,.

The free water is gravity run, that means you stand there with the 60 cc syringe, pour in the 30 cc's and wait. Sometimes 10 seconds sometimes 30 seconds.

Its a shot glass.

Also, there should be a water flush every hour.. so.. my orders read..

Jevity 1.2 @75cc/hr via pump with 25cc autoflush Q hr

30cc H2O a/p med pass

(The machine runs H2O automatically q hour)

The math is:

75x24 = 1800 cc of feeding

25x24= 600cc of water

60x3 = 180 cc of water a/p meds

TOTAL= 2580cc fluids in a day

Is 780 cc of water enough in a day? Its only 3 paper coffee cups...

sometimes not. so, free water via gravity.

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Specializes in LTC, Memory loss, PDN.

I'd have to clarify the order. The pt is on continous high calorie at a fairly slow rate so probably has intolerance to high volume or bolus, yet needs the calories. Judging from the caloric intake, pt is over 150 lbs (probably a lot bigger) so needs adequate free water. I'd run the numbers through the formula and clarify the order.

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I'm all confused. I guess if you have the newer pumps it would be easy.

I never see orders like this in ltc. We run the tube feeding on the pumps and normally have a q shift flush order.

Jevity @ 75 cc/hr and flush with 240 cc H20 q shift.

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Yeah.. I'm not sure what a typical flush is every shift which is why I asked. The nurse I was working with who had done frequent feedings read the order as a 30cc h20 flush every hour, so that's how we set it.

Later on I second guessed myself (as usual) and was freaking out thinking that might be too much h2o during the feeding.

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Specializes in Infection prevention and control.

Agreed that 30ml/hr flush is an odd amount, it is usually 25 ml/hr especially with a pump but I guess if you did the math that would only be an extra 120 ml q day...you gotta think too a lot of LTC facilities don't even have pumps with kangaroo piggy back pouch and do free water by gravity and unfortunately most don't get their water bolus. :crying2:

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Specializes in Acute Care, Rehab, Palliative.

Where I work you do a flush pre amd post medications as well as routine. We disconnect the feed tube and draw up the flush in a syringe and manually flush it through quickly to "flush" the tube. Our flushes are usually 100 mls or so.

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Agreed that 30ml/hr flush is an odd amount, it is usually 25 ml/hr especially with a pump but I guess if you did the math that would only be an extra 120 ml q day...you gotta think too a lot of LTC facilities don't even have pumps with kangaroo piggy back pouch and do free water by gravity and unfortunately most don't get their water bolus. :crying2:

:lol2: Just because we don't have the newer pumps (most LTCs) doesn't mean they don't get flushed. :uhoh3:

As I posted above..the orders are written for the feeds and most do have a down time for meds that need to be given on an empty stomach (dilantin for one) or for other reasons. When they are taken down and re started or for meds, they get flushed and then they also have an order to flush with xyz per shift.

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Specializes in Geriatrics, Home Health.

Could the order be for 30 cc water mixed with each can of Jevity?

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