Essential Steps for Starting Bolus Feeding
Starting bolus feeding requires careful preparation. Gathering all supplies and following healthcare provider instructions is necessary.
Supplies Needed
- Prescribed formula or blended food
- Room temperature water for flushing
- 60 mL syringe (catheter tip or ENFit)
- Clean measuring cup
- Extension sets (for button feeding tubes)
- Clean towel or washcloth
- Disposable gloves (recommended)
Preparing for the Feed
- Wash hands thoroughly with soap and water to maintain hygiene.
- Gather all supplies and put them on a clean surface.
- Check formula: Confirm the correct formula, amount, and expiration date. Ensure it is at room temperature. If refrigerated, remove it 30-60 minutes before use.
- Patient Positioning: Elevate the patient's head and torso at a 30- to 45-degree angle. Maintain this position for at least 30-60 minutes after feeding to prevent aspiration.
- Check tube: Confirm the correct tube position. Never proceed if you suspect the tube is dislodged.
The Bolus Feeding Procedure (Gravity Method)
The gravity method is frequently used for bolus feeding.
- Remove plunger from the 60 mL syringe.
- Connect syringe to feeding tube port. Attach the extension set first if using a button.
- Flush tube: Pour water (e.g., 30-60 mL) into the syringe. Let the water flow by gravity to clear the tube.
- Administer Formula: Pour the formula into the syringe. Fill it about halfway to avoid air. Adjust the flow rate by raising (faster) or lowering (slower) the syringe. A feed should take about 15-30 minutes.
- Refill: Continue adding formula before the syringe empties to prevent air.
- Flush Again: Flush the tube with the prescribed amount of water after all formula is delivered to prevent clogging.
- Disconnect: Close the clamp on the tube (if present), disconnect the syringe, and close the port.
Comparison of Bolus Feeding Methods
| Feature | Gravity Method | Plunger Method (Manual Push) |
|---|---|---|
| Mechanism | Formula flows by gravity. Rate controlled by syringe height. | Formula gently pushed with syringe plunger. |
| Control | Offers flow speed control by adjusting syringe height. | Requires gentle, consistent pressure to avoid forcing the feed. |
| Physiological Mimicry | Mimics natural eating process. | Can be quicker, but risks feeding intolerance if too fast. |
| Risk of Complications | Lower risk of bloating and cramping if administered slowly. | Higher risk of gastrointestinal issues if excessive pressure is applied. |
| Best for | Patients who can tolerate a slower pace. | Situations where gravity is too slow, but great care is needed. |
How to Handle Common Feeding Issues
Knowing how to react is key to handling issues.
Tube Clogging
- Do not force: Never force a blockage through the tube. This could cause damage.
- Attempt a gentle flush: Try flushing with warm water gently.
- Seek medical advice: If the clog remains, contact your provider. Special tools might be needed.
Signs of Feeding Intolerance
- Reduce Rate: Slow down the flow.
- Check Positioning: Ensure the patient is upright.
- Contact Provider: If symptoms persist, contact your healthcare provider.
Preventing Contamination and Clogs
- Practice good hand hygiene before and after handling equipment.
- Use clean equipment: Wash equipment with warm, soapy water after each use. Let them air dry completely.
- Flush the tube with water before and after feeding.
- Follow storage guidelines: Store opened formula in the refrigerator for up to 24 hours.
Post-Feeding Care
Proper care for the patient and equipment is essential.
- Maintain position: Keep the patient upright for 30-60 minutes after feeding.
- Clean equipment: Wash and rinse all equipment, and let it air dry.
- Provide oral care: Good mouth care is important.
- Monitor for issues: Watch for signs of discomfort. Report any problems to a professional.
For more detailed guidance, refer to the Tube Feeding Troubleshooting Guide from Memorial Sloan Kettering Cancer Center.
Conclusion
Bolus feeding is a safe method when done carefully. By understanding the equipment, following the steps, and practicing hygiene, caregivers can provide a positive experience. Consult your healthcare provider for the feeding plan, formula, and schedule.
