Enteral Feeding Needs: How to Calculate*
Note: This handout provides general suggestions on how to select and calculate tube feedings. Please
refer to your facility’s protocols to assure that your methods of selection and calculations comply with
your facility’s protocol.
Step 1: Estimate patient’s nutritional needs
 Conduct a complete nutrition assessment
 Determine protein, calories (kcal), fluid, fiber, and nutrient needs, based on information obtained from
nutrition assessment:
– Use your facility’s standard protocols for calculating these needs
– A sample form for enteral feeding is available at
http://www.nutrition411.com/component/k2/item/677-enteral-feeding-flow-sheet
Step 2: Select tube-feeding formula
 Consider patient’s age, medical condition, ability to tolerate feeding, medications, laboratory values,
and skin condition
 Answer the following:
– Does the patient require a disease-specific formula?
– Does the patient require a high-calorie or high-protein feeding?
 Choose an appropriate feeding for the patient’s medical condition
 Select a feeding that is available through your pharmacy
Step 3: Select method of feeding (bolus vs continuous)
 Many factors affect the tube-feeding method, including but not limited to a patient’s:
– Risk for aspiration
– Ability to ambulate
– Degree of consciousness
– Tolerance of feeding
Step 4: Determine volume of feeding to meet estimated calorie and protein needs
 Add water flushes, as needed, to meet fluid needs and keep tube patent
 Nutritional content of tube-feeding products is available:
– Online
– In literature from formula manufacturers
– On the label of the tube-feeding product
Calculate volume of feeding
 Volume of continuous feeding: (milliliters [mL]/hour of feeding)  (hours of feeding each [q] day) =
total volume of feeding
 Volume of bolus feeding: (number of bolus feedings/24 hours)  (number of mL in each bolus
feeding) = total volume of bolus feeding
Calculate calories provided by tube feeding
 (Number of calories/mL)  (total volume of feeding) = total calories provided by tube feeding
Calculate protein provided by tube feeding
 Check tube-feeding label for grams (g) protein/1000 mL
 (Number of g protein per 1000 mL)  (total liters [L] of feeding provided†) = protein in feeding
†
Total liters of feeding = total mL of feeding delivered  0.001
Calculate fluids provided by tube feeding
 Check tube-feeding label for free water content/8-fluid-ounce (fl oz) feeding or per 1000 mL of
continuous feeding
 For bolus feeding: (amount of free water per feeding)  (number of feedings provided)
 For continuous feeding: (total volume of tube feeding)  (mL free water/1000 mL) = free water in tube
feeding
Assure free water needs are met via feedings and flushes
 Estimated fluid needs minus fluids available in feedings = fluids needed in flushes to meet fluid needs
 Divide amount of fluid needed for flushes into at least three flushes q 24 hours or according to your
facility’s protocol (in addition, some protocols recommend 30 to 50 mL before and after feedings
and/or medication administration)
Step 5: Document
 Document the following:
– Volume of feeding provided
– Protein
– Kcal
– Fluids found in the feeding
– How they compare to the patient’s estimated needs
 Adjust volume provided, if necessary, to meet patient’s estimated needs
Step 6: Reevaluate feeding on a regular basis
 Reevaluate to assess:
– Tolerance
– Lab values
– Hydration status
– Weight
 Adjust volume of feeding and flushes, as needed, to maintain nutritional and hydration status
*Some enteral feeding patients require careful attention to nutrients provided, osmolality of feedings,
nitrogen available, or other specific concerns, which are not addressed in this basic tube-feeding
information. Method of delivery, tube-feeding formula selection, and nutrient needs are affected by
many variables, which also are not covered in this article.
Review Date 3/14
G-0877