How to do a tube feeding bolus?

According to Memorial Sloan Kettering Cancer Center, the bolus method is a common way to deliver formula through a feeding tube using a syringe. Learning how to do a tube feeding bolus correctly is essential for ensuring proper nutrition and comfort for the patient at home.

Quick Summary

This guide outlines the precise steps for performing a bolus tube feeding using a syringe and gravity, from gathering supplies to flushing the tube. It covers important safety protocols, proper patient positioning, and techniques for a smooth feeding process. The content also addresses common issues like bloating and clogging.

Key Points

• Prepare all supplies: Gather formula, a 60 mL syringe, water, and any necessary adaptors before beginning the feeding process.

• Position the patient correctly: Elevate the patient's head and torso to at least a 30-45 degree angle to prevent aspiration during and for one hour after the feeding.

• Flush the tube before and after: Clear the feeding tube with the prescribed amount of water both before starting the feed and after it's complete to prevent clogging.

• Use gravity to control flow: Remove the syringe plunger and hold the syringe at a height that allows the formula to flow steadily but not too quickly, mimicking a normal meal.

• Maintain hygiene: Always wash your hands and keep all equipment clean to prevent infection. Syringes should be replaced regularly.

• Troubleshoot for common problems: Learn how to handle issues like tube clogs, bloating, or nausea by adjusting the flow rate or venting the tube.

A bolus tube feeding is a method of delivering a 'meal' of formula several times a day over a short period, often using a large syringe and gravity. This process is different from a continuous feeding that uses a pump and delivers nutrients slowly over many hours. For many patients, bolus feeding more closely mimics the body’s natural eating pattern, offering greater flexibility and independence. This guide will detail the steps for administering a bolus feed and provide important safety tips.

Preparing for a Bolus Tube Feeding

Proper preparation is key to a smooth and safe feeding experience. Gather all necessary supplies and prepare the formula before beginning.

Gather your supplies

Before you start, make sure you have everything you need laid out on a clean, comfortable surface.

• Prescribed formula (at room temperature)
• Large-volume syringe (typically 60 mL)
• Water (room temperature tap water is usually fine unless your healthcare provider specifies sterile water)
• Button adapter or extension set (if you have a button-type gastrostomy tube)
• Clean paper towel or cloth
• Measuring cup or clean container for formula
• Hand sanitizer or soap and water for hand hygiene

Prepare the patient and formula

Patient positioning is crucial to prevent aspiration, where formula enters the lungs. The formula should also be ready to go.

1. Wash your hands. Perform thorough hand hygiene using soap and water for at least 20 seconds.
2. Position the patient. Ensure the patient is in an upright position with their head elevated at least 30 to 45 degrees, and remain in this position for about one hour after the feeding.
3. Prepare the formula. If using a canned formula, clean the top with an alcohol swab before opening. Pour the prescribed amount into a clean container. If the formula was refrigerated, allow it to warm to room temperature.

Administering the Bolus Feed with the Gravity Method

For many, the gravity method is the most common way to do a bolus feed. It relies on gravity to control the flow rate rather than a pump.

1. Flush the tube. Draw up the prescribed amount of water (e.g., 30 mL) into the syringe. Attach the syringe to the feeding tube and unclamp it. Allow the water to flow in by gravity, or gently push the plunger to start the flow if needed. Once flushed, reclamp the tube and remove the syringe.
2. Fill and attach the syringe. Remove the plunger from the syringe and place it in a clean location. Attach the empty syringe to the feeding tube and unclamp it.
3. Pour the formula. Hold the syringe upright and pour the formula into the barrel. Do not let the syringe empty completely to avoid introducing air into the stomach.
4. Control the flow rate. Adjust the height of the syringe to control the speed of the feeding.
   • Higher: Increases the speed of the flow.
   • Lower: Decreases the speed of the flow.
   • Gentle Pressure: If formula is not flowing, you may use the plunger to apply slight, gentle pressure to start it, but do not force the feeding.
5. Continue feeding. As the syringe empties, continue to pour in more formula until the entire prescribed volume has been administered. The feeding should typically take 15 to 30 minutes.

Post-Feeding Care and Hygiene

Proper aftercare is vital to prevent clogging and infection.

1. Final flush. When the feeding is complete, pour the prescribed amount of water into the syringe to clear the tube of any remaining formula.
2. Disconnect and clean. After the flush is finished, clamp the tube, remove the syringe and any extension sets, and cap the feeding tube.
3. Wash equipment. Clean the syringe, measuring cup, and any extension sets with warm, soapy water. Rinse thoroughly and allow them to air dry completely. Replace syringes and sets as recommended by your healthcare provider to prevent infection.

Common Problems and Solutions

Issue	Causes	Solutions
Clogged Tube	Insufficient flushing, medication buildup, or thick formula.	Flush with warm water using a back-and-forth motion with the plunger. Avoid acidic fluids like soda. DO NOT use excessive force. If the clog persists, contact a healthcare provider.
Nausea or Vomiting	Feeding too fast, gastric emptying issues, or formula intolerance.	Slow the rate of feeding by lowering the syringe. If using the plunger, reduce the speed. Ensure formula is at room temperature. Position the patient on their right side with the head elevated to facilitate gastric emptying.
Bloating	Feeding too quickly or air getting into the tube.	Try venting the tube by attaching an empty syringe and unclamping it to allow air to escape. Slow down the feeding rate. Do not let the syringe completely empty during the feed.
Leakage Around Site	The extension set is not properly locked into a button, the tube may be dislodged, or skin irritation is present.	Check that all connections are secure. If using a button, confirm the extension set is locked. If leakage is new or significant, contact your healthcare provider.

Bolus vs. Continuous Feeding

Bolus and continuous feedings are two methods for delivering enteral nutrition, each with distinct advantages.

• Bolus Feeding: Mimics a meal pattern, offering greater patient mobility and flexibility. It's more cost-effective as it doesn't require a pump. However, it can sometimes cause discomfort like bloating or nausea in sensitive patients if administered too quickly.
• Continuous Feeding: Delivers a steady infusion of formula over many hours, which is better tolerated by some patients, particularly those with a high risk of aspiration or reflux. It provides a constant level of nutrients but restricts patient mobility and is more expensive due to pump use.

Your healthcare team will determine which method is best based on the patient's nutritional needs and tolerance.

Conclusion

Performing a tube feeding bolus correctly is a manageable and essential caregiving task that, with practice, will become routine. By following the steps for preparation, administration, and post-feeding care, you can ensure the patient receives the nutrition they need safely and comfortably. Always maintain proper hand hygiene, ensure the patient is correctly positioned, and monitor for any signs of intolerance. If issues like tube clogging or excessive bloating arise, follow the recommended troubleshooting steps. Always consult with a healthcare provider for any persistent or significant problems or before making changes to a feeding regimen. For additional resources and support, refer to your hospital's patient education materials or visit reputable health authority websites like Memorial Sloan Kettering Cancer Center.

Frequently Asked Questions

What supplies are needed to do a tube feeding bolus?

You will need the prescribed formula, a large-volume (typically 60 mL) syringe, warm water for flushing, a clean container for the formula, and an extension set or adapter if using a button-style gastrostomy tube.

How do I control the speed of a bolus feeding?

The speed of the feeding is controlled by adjusting the height of the syringe. Hold the syringe higher above the stomach to increase the flow rate and lower it to decrease the flow rate.

What should I do if the feeding tube clogs?

Gently flush the tube with warm water using a back-and-forth motion with the plunger of the syringe. Do not use excessive force or acidic liquids. If the clog persists, contact your healthcare provider for further guidance.

How should the patient be positioned during a bolus feeding?

The patient must be positioned upright with their head and shoulders elevated at least 30 to 45 degrees. This position should be maintained for about one hour after the feeding to prevent aspiration.

What are the signs of poor feeding tolerance?

Signs of intolerance can include nausea, vomiting, abdominal bloating or distention, and diarrhea. If these occur, try slowing the feeding rate, and if symptoms persist, notify your healthcare provider.

Is it better to do a bolus or continuous feeding?

The best method depends on the patient's specific needs and tolerance, as determined by their healthcare team. Bolus feeding mimics a natural eating pattern, while continuous feeding may be better for patients sensitive to volume or at high risk of aspiration.

How often should I clean or replace my feeding equipment?

Syringes and extension sets should be washed with warm, soapy water after each use and air-dried. Your home care company or healthcare provider will give specific instructions on how often to replace equipment, typically using a new syringe every 1 to 2 days.