Rate Based calculation steps
Identify tube feeding order and flushes
calculate total volume administered
calculate total calories provided
calculate total protein provided
calculate water provided by formula and flushes
Step 2: calculate total volume provided by formula
80 mL/hr x 24 hours= 1920 mL (1.92L)
1920 mL (1.92 L)
Step 3: calculate total calories provided by formula
1.92L x 1200 kcal/L=
2308 kcals
Step 4: calculate total protein provided by formula
1.92 L x 54 g protien=
104 g protein
step 5: calculate water provided by formula and water flushes
water in formula: 1920 mL x 0.81 = 1555 mL
water flushes: 100 mL x 6 flushes = 600 mL
total water provided: 1555 mL + 600 mL = 2155 mL total
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Step 1. Identify tube feeding order and flushes
MD order: Fibersource HN at 80 mL/hr continuously with a 100 ML water flush Q4H.
(Note: one liter of Fibersource HN = 1200 k cal, 54 g protien, 81% free water)
Sample Rate- Based Calculation – based off nutritional requirements
- Identify nutritional needs
- Determine formula volume needed per day and rate
- Calculate total calories provided
- Calculate total protein provided
- Calculate free water provided
- Calculate additional water flushes needed
- Write rate- based feeding order, including water flushes
Step 1. Identify nutrition needs
Assessment by RDN shows pt requires 1800 kcals, 70 g protein, and 1800 mL fluid. Pt requires standard polymeric formula.
2. Determine formula volume needed per day rate
nutren1.0 will be used (standard polymeric formula)
contains 1000 kcal, 40 g protien, and 83% free water per one liter
1800 kcal daily/ 1.0 kcal. mL= 1800 mL
1800 mL/24 hours per day = 75 mL/hr
3. calculate total calories provided
1800 mL daily x 1.0 kcal/mL = 1800 kcal daily
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Calculate total protein provided
1.8 L (1800 mL) x 40 g protein/L = 72 grams
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Calculate free water provided:
1800 mL x .83 = 1494 mL/d free water
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6. Calculate additional water flushes
total flush requirements = 1800 mL
1800 mL - 1494 mL free water = 306 mL needed
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7. Write rate based feeding order, including water flushes
Nutren 1.0 at 75 mL/hr with a 150 mL water flush twice daily.
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Bolus defined
a formula administered over a 5- 20 minute period using a syringe (60 mL syringe) several times each day
Bolus order components
(administer 240 mL of Nutren 1.5 Q4H with a 100 mL flush with each feeding)
Formula name
bolus volume
frequency of administration
water flushes
time frame
Advantages of Bolus feedings
Rapid administration
inexpensive
mimics mealtime
portable
Disadvantages of Bolus feedings
rapid administration
manual dexterity
higher risk of complications
We nourish website for bolus tube feedings or (syringe feeding)
must flush feeding tube with 1 oz of water or more
Sample Bolus calculation (steps)
(calculating a bolus feeding off of an existing order)
1.Identify tube feeding order and flushes
2. calculate total volume administered
3. calculate total calories provided
4. calculate total protein provided
5. calculate water provided by formula and flushes
1.Identify tube feeding order and flushes
Physician orders "one can of nutren1.5 Q4H from 0800-2000,
Administer a 100 mL water flush with each feeding. " (Note: Nutren 1.5 contains 375 kcal/can, 17 g protein/ can and 76% free water)
2. Calculate total volume provided by formula
One can Q4H from 0800-2000 (8 am to 8 pm)
one can feeding at 8 am, 12 pm, 4 pm, 8 pm
each can of Nutern1.5 = 250 mL
Four cans daily = 1000 mL
3. Calculate total calories provided by formula
Calculate by cans: 250 mL can of Nutren 1.5 = 375 kcal/can x 4 cans = 1500 kcals
calculate by total volume: 250 mL can x 4 cans = 1000 mL x 1.5 kcal/mL = 1500 kcals
4. calculate total protein provided by formula:
calculate by cans:
calculate by cans: 250 mL can of Nutren 1.5 = 17 g pro/can x 4 cans = 68 g. protein
Calculate by total volume: 1000 mL = 68 g. protein
5. calculate water provided by formula and water flushes
water in formula: 250 mL can of Nutren 1.5 x 4 cans = 1000 mL x 0.76 (76% free water) = 760 mL free water
water flushes: 100 mL x 4 total feedings = 400 mL
total water provided: 760 mL + 400 mL = 1160 mL total
Sample Bolus Calculation:
Calculating a bolus feeding based off of nutritional requirements
1. Identify nutritional needs.
2. Determine number of cans per day
3. Calculate total calories per provided
4. Calculate total protein provided
5. Calculate free water provided
6. Calculate additional water flushes
7. Write bolus feeding order, including water flushes
1. Identify nutritional needs.
Nutritional assessment by RDN reveals patient requires 2000 kcals, 80 g protein, and 1800 mL fluid
2. Determine formula and number of cans per day
A concentrated, 2.0 k cal/mL formula will be used - Nutren 2.0
One can of Nutren 2.0 = 500 kcals/can
2000 kcals required / 500 kcals per can = 4 cans daily
3. Calculate total calories provided
4 cans/day x 500 kcals daily = 2000 kcals
4. Calculate total protein provided
4 cans/day x 21 g protein = 84 g protein
5. Calculate free water provided
One can = 250 mL
4 cans/day x 250 mL = 1000 mL
69% free water per container in Nutren 2.0
1000 mL x 0.69 = 690 mL free water
6. Calculate additional water flushes
Total fluid requirements = 1800 mL
1800 mL - 690 mL free water = 1100 mL needed
7. CWrite bolus feeding order, including water flushes
One can of Nutren 2.0 administered Q 6H ( four times daily) with a 280 mL water flush with each feeding