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Refresh Home Nutrition Support Program Refresh Formulary Guide Tube Feeding Per 1000 mL Intact Protein Ordering Enteral Prescriptions When ordering a tube feeding, the following information will help ensure an accurate order. • Formula name (or equivalent) • Method of administration (bolus, gravity, or pump) • For bolus or gravity: total formula volume (mL, cans, or calories) and amount per feeding frequency/day • For pump: rate (mL/hour) and hours/day • Water flushes: total amount and amount per frequency/day • Route of administration (NG, NJ, GT, or JT) • Indicate tube type for supplies: GT or JT (standard vs. low profile/button) Peptamen® B4150 B4154 Novasource® Renal B4154 • Flush feeding tube with water before and after administering each medication via feeding tube. Avoid mixing medications with formula, as precipitation may occur, resulting in feeding tube occlusion. B4153 B4153 PediaSure® Promote® Enteral Formula 1.0 Cal with Fiber Promote® with Fiber Glucerna® 1.0 Cal Glucerna® 1.2 Cal Pulmocare® Nepro® with Carb Steady™ Vital® 1.0 Cal Vital® 1.0 Cal Oxepa® Vital® 1.5 Cal PediaSure® Peptide 1.0 Cal PediaSure® Peptide 1.5 Cal Calorically dense, Calorically dense, Calorically dense, Complete complete nutrition complete complete liquid nutrition nutrition nutrition with fiber Complete liquid nutrition Very high protein, complete nutrition Very high protein, complete nutrition with fiber Complete nutrition for patients with hyperglycemia Advanced control Complete tube feeding liquid nutrition Nutritionally Complete, complete formula peptide-based nutrition Complete, peptide-based nutrition Complete, peptide-based nutrition with EPA, DHA, and PREBIO¹™ soluble fiber Complete, Complete, calorically dense, peptide-based peptide-based formula nutrition Complete, peptide-based formula 1.2 1.5 1.5 2.0 1.0 1.0 1.0 1.0 1.0 1.2 1.5 2.0 1.0 1.0 1.2 1.5 1.0 1.5 54 54 68 68 84 30 30 64 64 45.2 60 68 90.7 40 40 76 68 30 45 16% 18% 18% 18% 18% 16% 12% 12% 25% 25% 18% 20% 18% 18% 16% 16% 25% 18% 12% 12% 136 148 156 164 176 176 216 110 110 112 124 100 100 100 183 128 128 112 188 136 180 Carbohydrate (% of kcal) 54% 54% 53% 53% 47% 47% 43% 44% 44% 45% 45% 40% 36% 26% 37% 51% 49% 35% 49% 54% 48% Fat (g) 34 34 40 40 60 59.2 92 49.6 49.6 34 34 47.6 58.8 94.8 100 39 40 54 56 38.4 68 Fat (% of kcal) 30% 30% 29% 29% 35% 35% 41% 44% 44% 30% 30% 42% 44% 56% 45% 33% 35% 40% 33% 34% 40% Fiber (g) N/A 15.2 N/A 15.2 N/A 15.2 N/A N/A 6 N/A 15.2 15.2 15.2 N/A N/A N/A 4 6 N/A 3.6 5.6 Water (%) 85% 83% 81% 81% 76% 76% 69% 85% 85% 84% 83% 84% 82% 78% 72% 85% 84% 81% 77% 84% 77% Sodium (mg) 880 880 1120 1120 1300 1300 1500 460 460 880 880 740 1060 1168 945 560 560 800 1040 460 692 Potassium (mg) 1600 1600 1920 1920 2400 2400 2100 1320 1320 1600 1600 1400 1600 1872 945 1500 1500 1600 1880 1320 1980 Phosphorus (mg) 800 800 960 960 1200 1200 1480 840 840 800 800 720 800 1200 819 700 700 800 1000 840 1352 Calcium (mg) 800 800 960 960 1200 1200 1600 1200 1200 800 800 720 800 1200 840 800 800 800 1000 1120 1650 Osmolality (mOsm/kg) 330 340 510 480 530 650 780 350 350 300 330 280 450 330 - 450 800 270 300 390 550 390 - 435 450 Meet or exceed 100% RDI/DRI (mL) 1500 1500 1250 1250 1000 1000 750 1-8 years 1000 mL, 1-8 years 1000 mL, 1500 9-13 years 1500 mL 9-13 years 1500 mL 1500 1500 1250 1000 1000* 1500 1500 1250 1000 1-8 years 1000 mL, 1-8 years 750 mL, 9-13 years 1500 mL 9-13 years 1000 mL Nutren® 1.5 B4150 B4150 B4150 B4150 B4152 Osmolite® 1 Cal Jevity® 1 Cal Osmolite® 1.2 Cal Jevity® 1.2 Cal Osmolite® 1.5 Cal Jevity® 1.5 Cal Description Complete nutrition Complete nutrition with fiber High nitrogen, complete nutrition High nitrogen, complete nutrition with fiber Calories per mL 1.0 1.0 1.2 Protein (g) 40 40 Protein (% of kcal) 16% Carbohydrate (g) Alternate to • Flush feeding tube with water before and after every bolus/ gravity feeding or at least every 4-6 hours for continuous feeding, as per physician orders. Volume of water flushes depends on fluid requirements. Peptamen® 1.5 Fibersource® HN • Enteral nutrition should be initiated with full strength formula, and rate gradually increased as tolerated to goal volume. • Hold feedings and notify physician if patient experiences abdominal distention, elevated gastric residuals, and/or vomiting. Possible interventions for feeding intolerance may include: reduce or discontinue narcotic medications, trial on a more tolerated formula, administer feeds at room temperature, reduce infusion rate by 20-25 ml/hr until tolerance is established, and/or consider use of a prokinetic agent if delayed gastric emptying is identified. Peptamen AF® B4153 Peptamen® with Prebio¹™ B4153 Nutren® 1.0 Fiber Isosource® HN Product Name ◊ † Isosource® 1.5 Cal B4152 Nutren® 2.0 Nutren Junior® B4152 B4160 Nutren Junior® Fiber B4160 TwoCal® HN PediaSure® Enteral Formula 1.0 Cal Replete® Replete® Fiber Glytrol® B4150 Peptide-Based Diabetisource® AC Nutren® Pulmonary B4154 B4154 Nutren® 1.0 Enteral Care Guidelines • To reduce risk of aspiration, have the patient remain in a seated position or elevate the head of the bed to greater than 30 to 45 degrees during feeding and at least 1 hour after feeding is completed. If giving a bolus feeding, wait at least an hour before lying having the patient lie down. Condition Specific * Except for vitamin A, chloride, phosphorus, and magnesium pertains to Novasource Renal and Meet or exceed 100% RDI/DRI (mL). ◊ Registered trademarks of Société des Produits Nestlé S.A., Vevey, Switzerland. † Registered trademarks of Abbott Laboratories. These recommendations are guidelines only and do not replace expert clinical advice. Patients should consult their clinicians regarding use of tube feeding products and any concerns they may have. Disclaimers: All formula substitutions require clinical judgment; please contact a clinician for appropriateness of alternative options. Not all clinical considerations are included and the listed alternatives may not be nutritionally comparable or equivalent in all respects. All product information is obtained from product literature as available upon the date of issue and is subject to change. For specific nutritional information, please consult the manufacturer. For assistance in Nestlé product selection and clinical application, call Nestlé at 1-800-422-ASK2 (2752). In addition, please note the following: PEPTAMEN® formulas contain milk protein. May not be appropriate for individuals with cow’s milk protein allergy. © 2016 Nestlé. Reprinted with permission. Except where noted, all trademarks are owned by Société des Produits Nestlé S.A., Vevey, Switzerland. Peptamen Junior® Peptamen Junior® with Prebio¹™ 1.5 B4161 B4161