Tube feeding Q

leslie :-D · Mar 17, 2005

I'm :uhoh21: about this.
My order said to a Jevity bolus of 100cc's at noon.
The nurse told me to set the rate at 125ml/hr on the machine.
How can the rate be set to give a higher dose than what was ordered? It looks to *me* that the patient will end up getting 125cc's/hr instead of 100.
Yes, I'm confused.

hmmmmm. unless she's thinking of a potential for residual. would you be uncomfortable asking for her rationale?

leslie

meownsmile, BSN, RN · Mar 17, 2005

Last i knew, you didnt put a bolus feeding on a pump. The idea behind a bolus feeding is to allow the patient or see if they can tolerate more quantity in their stomach so putting it in with a pump isnt going to accomplish the goal.

When the Dr orders a bolus feeding that is what should be done. It's not the nurses job to decide to drip it in at 100 or 125ml/hr. I agree it was probly the Drs intent to have the bolus instilled then check residual after 1 hour. If the order wasnt clear or complete you should have called the Dr and gotten confirmation on what he actually was ordering.

Also,, it may sound "old fashioned" but maybe this is a good example of why nurses should make rounds with the Drs. You can clearify their orders as they write them, ask questions as they are visiting their patients, get a sense of what their plan is for the patient. I know it takes time and we dont have a lot of that, but it really does help prevent situations just like this.

begalli · Mar 17, 2005

Does the tubing hold 25mls? This is the only thing I can think of why someone might enter more, but even that wouldn't matter if the tubing was already primed.

Bolus to me mean bolus - all at once. It's weird that it was administered over an hour on a pump unless the oder specifically read 100 ml bolus over one hour.

txspadequeenRN, BSN, RN · Mar 17, 2005

If I were you I would bolus 100 cc's as ordered. The other nurse is incorrect if she puts the pump on at 125 cc's/hr. :)

txspadequeenRN, BSN, RN · Mar 17, 2005

If this is a once a day order the tubing should be new and the tubing should be primed from the 100 cc's. One cannot gauge how many cc's are in the tube.

Does the tubing hold 25mls? This is the only thing I can think of why someone might enter more, but even that wouldn't matter if the tubing was already primed.
Bolus to me mean bolus - all at once. It's weird that it was administered over an hour on a pump unless the oder specifically read 100 ml bolus over one hour.

begalli · Mar 17, 2005

One cannot gauge how many cc's are in the tube.

Actually you can because it says on the packaging of every tubing I've ever encountered. Our drip tubing in the ICU takes 16 mls to prime (this is important to know when you're hanging a controlled substance). Our regular maintenance tubing is 22 ml. I don't know about the keofeed tubing, I never really looked.

CoffeeRTC, BSN, RN · Mar 18, 2005

Umm...just give the 100 ml bolus...it will only take about 5 minutes...open the can or bottle, pour it in the syringe...let it go in to gravity. or just pull it up and give it....why bother with a pump???

steelcityrn, RN · Mar 18, 2005

I would rather see the original order first before I commented on someone making a mistake. When your a student, you should be asking questions.

barefootlady, ADN, RN · Mar 18, 2005

A bolus feeding is just that, it is not to be given by pump. I would measure the amount, check for placement/patency, give bolus then clear tube with 10 to 15 cc of H20. Remember if tube is not cleared, tube sometimes stop up. If there is no order from doctor or facility does not have a protocol to clear tube with water after bolus feeding, then that is a good time to talk with doctor and get an order for it, also clear up feeding questions. Still a bolus feeding is never given by pump unless stated.

LPNer · Mar 18, 2005

Aside from the fact that a bolus doesn't need to go on a pump because you stand there and pour it in one syringeful at a time.

But... if you are REALLy strapped for time, putting a 100cc bolus on a pump set at 125ccs/hour will run the bolus over about 48 minutes. The 125 you set on the pump is how fast you want it to run in, not how much you want to run in. 48 minutes is a little slow for a bolus though. It should run in at 350 - 400 so that is will run deliver in 15 - 20 minutes.

Leaving a pt alone while TF runs at a bolus rate is dangerous. I would not do it. Stand there and bolus the TF. Evaluate the pt. Care for your pt. Enough said.