Question for those who do frequent tube feedings

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?
Quote from 09NewGradIt 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?

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..

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.

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 feeding25x24= 600cc of water60x3 = 180 cc of water a/p medsTOTAL= 2580cc fluids in a dayIs 780 cc of water enough in a day? Its only 3 paper coffee cups...sometimes not. so, free water via gravity.

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.

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.

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.

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.

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.

Quote from NoAverageLPNAgreed 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.

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

"Is 780 cc of water enough in a day? Its only 3 paper coffee cups...sometimes not. so, free water via gravity."Probablly is...Don't forget, the formula has water in it too..Usually somewhere around 200ml in each 250ml of formula. So they get all that water too. You can find this information somewhere on the Jevity package which can be useful if you want to check and see that your patient is getting enough fluids.