front 1 Rate Based calculation steps  back 1 Identify tube feeding order and flushes calculate total volume administered calculate total calories provided calculate total protein provided calculate water provided by formula and flushes 
front 2 Step 2: calculate total volume provided by formula 80 mL/hr x 24 hours= 1920 mL (1.92L)  back 2 1920 mL (1.92 L) 
front 3 Step 3: calculate total calories provided by formula 1.92L x 1200 kcal/L=  back 3 2308 kcals 
front 4 Step 4: calculate total protein provided by formula 1.92 L x 54 g protien=  back 4 104 g protein 
front 5 step 5: calculate water provided by formula and water flushes water in formula: 1920 mL x 0.81 = 1555 mL water flushes: 100 mL x 6 flushes = 600 mL total water provided: 1555 mL + 600 mL = 2155 mL total  back 5 no data 
front 6 Step 1. Identify tube feeding order and flushes MD order: Fibersource HN at 80 mL/hr continuously with a 100 ML water flush Q4H. (Note: one liter of Fibersource HN = 1200 k cal, 54 g protien, 81% free water)  back 6 Sample Rate Based Calculation – based off nutritional requirements

front 7 Step 1. Identify nutrition needs Assessment by RDN shows pt requires 1800 kcals, 70 g protein, and 1800 mL fluid. Pt requires standard polymeric formula.  back 7 2. Determine formula volume needed per day rate nutren1.0 will be used (standard polymeric formula) contains 1000 kcal, 40 g protien, and 83% free water per one liter 1800 kcal daily/ 1.0 kcal. mL= 1800 mL 1800 mL/24 hours per day = 75 mL/hr 
front 8 3. calculate total calories provided 1800 mL daily x 1.0 kcal/mL = 1800 kcal daily  back 8 no data 
front 9 Calculate total protein provided 1.8 L (1800 mL) x 40 g protein/L = 72 grams  back 9 no data 
front 10 Calculate free water provided: 1800 mL x .83 = 1494 mL/d free water  back 10 no data 
front 11 6. Calculate additional water flushes total flush requirements = 1800 mL 1800 mL  1494 mL free water = 306 mL needed  back 11 no data 
front 12 7. Write rate based feeding order, including water flushes Nutren 1.0 at 75 mL/hr with a 150 mL water flush twice daily.  back 12 no data 
front 13 Bolus defined  back 13 a formula administered over a 5 20 minute period using a syringe (60 mL syringe) several times each day 
front 14 Bolus order components (administer 240 mL of Nutren 1.5 Q4H with a 100 mL flush with each feeding)  back 14 Formula name bolus volume frequency of administration water flushes time frame 
front 15 Advantages of Bolus feedings  back 15 Rapid administration inexpensive mimics mealtime portable 
front 16 Disadvantages of Bolus feedings  back 16 rapid administration manual dexterity higher risk of complications 
front 17 We nourish website for bolus tube feedings or (syringe feeding)  back 17 must flush feeding tube with 1 oz of water or more 
front 18 Sample Bolus calculation (steps) (calculating a bolus feeding off of an existing order)  back 18 1.Identify tube feeding order and flushes 2. calculate total volume administered 3. calculate total calories provided 4. calculate total protein provided 5. calculate water provided by formula and flushes 
front 19 1.Identify tube feeding order and flushes Physician orders "one can of nutren1.5 Q4H from 08002000,  back 19 Administer a 100 mL water flush with each feeding. " (Note: Nutren 1.5 contains 375 kcal/can, 17 g protein/ can and 76% free water) 
front 20 2. Calculate total volume provided by formula  back 20 One can Q4H from 08002000 (8 am to 8 pm) one can feeding at 8 am, 12 pm, 4 pm, 8 pm each can of Nutern1.5 = 250 mL Four cans daily = 1000 mL 
front 21 3. Calculate total calories provided by formula  back 21 Calculate by cans: 250 mL can of Nutren 1.5 = 375 kcal/can x 4 cans = 1500 kcals calculate by total volume: 250 mL can x 4 cans = 1000 mL x 1.5 kcal/mL = 1500 kcals 
front 22 4. calculate total protein provided by formula: calculate by cans:  back 22 calculate by cans: 250 mL can of Nutren 1.5 = 17 g pro/can x 4 cans = 68 g. protein Calculate by total volume: 1000 mL = 68 g. protein 
front 23 5. calculate water provided by formula and water flushes  back 23 water in formula: 250 mL can of Nutren 1.5 x 4 cans = 1000 mL x 0.76 (76% free water) = 760 mL free water water flushes: 100 mL x 4 total feedings = 400 mL total water provided: 760 mL + 400 mL = 1160 mL total 
front 24 Sample Bolus Calculation: Calculating a bolus feeding based off of nutritional requirements  back 24 1. Identify nutritional needs. 2. Determine number of cans per day 3. Calculate total calories per provided 4. Calculate total protein provided 5. Calculate free water provided 6. Calculate additional water flushes 7. Write bolus feeding order, including water flushes 
front 25 1. Identify nutritional needs.  back 25 Nutritional assessment by RDN reveals patient requires 2000 kcals, 80 g protein, and 1800 mL fluid 
front 26 2. Determine formula and number of cans per day  back 26 A concentrated, 2.0 k cal/mL formula will be used  Nutren 2.0 One can of Nutren 2.0 = 500 kcals/can 2000 kcals required / 500 kcals per can = 4 cans daily 
front 27 3. Calculate total calories provided  back 27 4 cans/day x 500 kcals daily = 2000 kcals 
front 28 4. Calculate total protein provided  back 28 4 cans/day x 21 g protein = 84 g protein 
front 29 5. Calculate free water provided  back 29 One can = 250 mL 4 cans/day x 250 mL = 1000 mL 69% free water per container in Nutren 2.0 1000 mL x 0.69 = 690 mL free water 
front 30 6. Calculate additional water flushes  back 30 Total fluid requirements = 1800 mL 1800 mL  690 mL free water = 1100 mL needed 
front 31 7. CWrite bolus feeding order, including water flushes  back 31 One can of Nutren 2.0 administered Q 6H ( four times daily) with a 280 mL water flush with each feeding 