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|Nutrition and You: Tube Feeding Tips|
Weight gain and subsequent maintenance are common concerns for the enteral, or tube-fed, patient. Working with your dietitian and physician, you can find ways to increase your caloric intake. Generally speaking, a weight gain of a half-pound to a full pound per week can be achieved with an increase of approximately 250–500 calories per day. When comparing the enteral diet to the oral diet, strategies for increasing calories are quite similar. These strategies include:
Increase the VolumeIn an oral diet, you would first simply try eating more. The same idea applies to the enteral diet. If you use the bolus method for tube feeding, the most basic strategy to increase calories is to increase the volume of each bolus meal. Try slowly increasing a meal volume by 30- to 60-mL (1- to 2-ounce) increments. Often, the adult stomach can tolerate a total volume of 240–480 mL per meal. If you are receiving a continuous feed via pump, a slow increase in rate (start with increments of 2–5 mL/hour, as tolerated) can be used to obtain a goal of an additional 120–480 mL per day.
Increase the FrequencyIf unable to tolerate additional volume per bolus feeding, you can try increasing the number of feedings per day. Again, an increase of 120–480 mL per day is a practical goal. This can be accomplished by adding an additional meal per day (space meals at least two hours apart). Or, you can add two to three smaller, 60- to 120-mL “snacks” between normally scheduled bolus feedings, or add one smaller feeding at bedtime.
Increase the DensityIn terms of food, it is understood that a bite of cheesecake packs more calories than the same amount of fruit does. This concept also applies to various enteral formulas. If an increase in formula volume or frequency is not tolerated, the next strategy is to manipulate the formula density.
Calorie density is noted in the name of most commercial formulas. A “1.0” formula provides one calorie per milliliter. Try increasing the formula density incrementally, using formulas that provide 1.2, 1.5, and 2.0 cal/mL. (Note: High-density formulas contain less water than low-density formulas. If switching to a denser formula, additional water will have to be provided as flush. Consult the formula label to compare total water content in each product. A registered dietitian can help you determine your total fluid needs.)
If using a blenderized formula, you can increase the density by mixing the formula with less water. A variety of products can also be added to enhance nutrition without substantially altering volume. These include powdered products such as a protein module or a liquid MCT (medium-chain-triglyceride) oil. MCT oil is more readily digested than other forms of fat, making it a good choice for those struggling with diarrhea and malabsorption.
SummaryKeep in mind that not all interventions are appropriate for every patient. Be sure to talk to your doctor before making any changes to the enteral regimen that has been prescribed for you. Working with your doctor and dietitian to formulate an individualized, balanced approach for increasing calories is the best way to go!
Written by Brittany L. Wright, RD, Enteral Specialist, Coram CVS/specialty infusion services. Reviewed by Carol Ireton-Jones, PhD, RD, LD, and Laura Matarese, PhD, RD, CNSC. References available upon request.
LifelineLetter, September/October 2014