Tube Feeds
Orders
1. "Dobb-Hoff Tube" is a Duotube
2. "XR Abdomen 1 View Exam"
to ensure feeding tube placement is checked (confirm placement ok on XR either yourself or final read or with your senior before starting tube feeds - can do the orders below and then just put a nursing communication note saying don't start TFs until XR done and reviewed. They should know this too but don't assume).
3. Tube Feed Power-plan
- Keep all the auto-checked parts of the powerplan checked
3A) Tube Feed Formula
If diabetic, choose Diabetisource. Otherwise if kidney function is fine, choose Impact Peptide 1.5 or Isosource.
Generally you can start tube feeds with the powerplan on your own at a low rate. Part of the powerplan is a nutrition consult, they will review your choice of tube feed and rate to make sure everything is ok and you can adjust accordingly.
Selecting a Tube Feed Food Formulation - EMCrit Project
| Tube feed choice | Reasons for use / comments |
| Diabetisource AC | Diabetic default |
| Impact peptide 1.5 | Make sure they have good kidney function if you have to choose this. Avoid in sepsis but good for post-trauma and post-op patients. |
| Isosource 1.5 | Good #1 choice |
| Jevity 1.2 | Good #1 choice |
| Nepro Carb steady | Good for significant AKI / CKD (lower protein and K+) |
| Osmolite | Good #1 choice |
| Nutren 2.0 | Anything that's 2.0 is good for the fluid-restricted. |
| Kate Farms | this is the equivalent to a GI easy if someone having diarrhea. |
3B) Tube Feed Module/Additive
Safe to just choose 1 Prosource packet per day until Nutrition tells you otherwise. If Diabetic, choose Arginaid (powder)
3C) Tube Feed Flushes
- 30q4 is generally ok, just to maintain tube patency
- This is not the same as free water flushes (see below) which is actually used to regular sodium
3D) Free water flushes
- these are not checked by default in the powerplan, you must choose
- these actually matter and both the flush content (NS vs water) and frequency will change the patient's sodium
- Generally ok to start with