Formula Feed Delivery

By

Dr. Anam Aman

Intermittent feedings
• A day’s nutrient needs can be met by
• Intermittent feedings :delivering relatively large amounts of formula
several times per day
• Intermittent feedings are best tolerated when they are delivered into
the stomach (not the intestine).
• Generally, a total of about 250 to 400 milliliters is delivered over 20 to
40 minutes using a gravity drip method or an infusion pump
• Intermittent feedings may start with 60 to 120 milliliters at the initial
feeding and be increased by 30 to 60 milliliters at each feeding until
the goal volume is reached
Intermittent feedings
• .Because of the relatively high volume of formula delivered at a time,
intermittent feedings may be difficult for some patients to tolerate,
and the risk of aspiration may be higher than with continuous
feedings.
• An advantage of intermittent feedings is that they are similar to the
usual pattern of eating and allow the patient freedom of movement
between meal
Continuous feedings
• Continuous feedings are delivered slowly and at a constant rate over
a period of 8 to 24 hours.
• Continuous feedings are used in patients who receive intestinal
feedings. This method of feeding is also recommended for critically ill
patients, because delivering relatively small volumes at a time may
reduce nausea, diarrhea, and possibly, the risk of aspiration.
• An infusion pump is required to ensure accurate and steady flow
rates; consequently, the feedings can limit the patient’s freedom of
movement and are also more costly
Continuous feedings
• Continuous feedings may start at about 20 to 50 milliliters per hour
and be raised by 10 to 25 milliliters per hour every 4 to 8 hours
• Concentrated formulas are often started at the slower rates. For both
intermittent and continuous feedings, the delivery rate and amount
of increase depend on the patient’s tolerance to the formula.
• If the new rate is not tolerated, the rate of delivery progresses more
slowly to give the person additional time to adapt.
• If a patient on intermittent feeding cannot tolerate the feeding,
continuous feeding may be a better choice
Bolus feedings
• Rapid delivery of a large volume of formula into the stomach (250 to
500 milliliters in less than 20 minutes) is called a bolus feeding.
• This type of feeding may be given every 3 to 4 hours using a syring
• Bolus feedings can cause abdominal discomfort, nausea, and
cramping in some patients, especially when the feeding is initiated
• The risk of aspiration is also greater than with other methods of
feeding.
• For these reasons, bolus feedings are used only in patients who are
not critically ill.
Checking Gastric Residuals
• When a patient receives a gastric feeding, the nurse regularly measures
the gastric residual volume (the volume of formula remaining in the
stomach after feeding)
• To ensure that the stomach is emptying properly.
• The gastric residual is measured by gently withdrawing the gastric
contents through the feeding tube using a syringe, usually every feeding
and every 4 to 6 hours during continuous feedings.
• It is recommend that an evaluation be conducted if the gastric residual
exceeds 200 milliliters and that feedings be withheld if it exceeds 500
milliliters.
• If the tendency to accumulate fluids persists, the physician may
recommend intestinal feedings or begin drug therapy to stimulate gastric
emptying