Written by Lisa Grentz, MS, RD, CD
Whether using commercial enteral formula or a homemade food blend, bolusing is an efficient method for administering enteral feeds. Bolus feeding requires the use of a syringe to deliver formula or food blends through the feeding tube. The rate of infusion is controlled by how fast the plunger is pushed or by removing the plunger and holding the syringe up, letting gravity take control and allowing formula to flow down through the tube. Bolus feeds are usually administered over 10 to 20 minutes and given several times throughout the day. This rapid feeding method does not impair nutrient absorption and has the advantages of being practical and convenient for use in the home setting, mimics a more physiologic feeding schedule (similar to a regular meal/snack feeding pattern spaced every few hours during the day), provides increased flexibility with feeding times/schedules (able to work around medical appointment, therapy, etc.), provides increased patient mobility, and is less expensive than gravity or pump administered feeds.
How to bolus feed:
1. Wash your hands before touching your child’s skin, feeding tube, and supplies.
2. If your child has a low-profile gastrostomy tube (GT), prime the extension tube to remove any air before attaching it to the GT.
a. To prime the extension, clamp the extension set near the end of the tube.
3. Remove the plunger from a 60 mL syringe and attach the syringe to the feeding port of the extension tube.
4. Pour to 10-20 mL of formula or blended food into the syringe.
5. Unclamp the extension tube, allowing formula or blended food to flow all the way to the tip then clamp the extension set again.
6. Attach the extension set to the feeding tube.
7. Hold up the extension tube with the attached syringe with one hand.
8. Use your other hand to slowly pour formula or blended food into the syringe.
9. Unclamp the extension set to allow formula or blended to flow by gravity into your child’s stomach. For more viscous solutions, you can use the plunger to push the formula or blended food through. Continue this process until the entire feeding volume has been delivered.
10. Flush your feeding tube with water as recommended by your medical team.
11. Remove the syringe, close the feeding port, clamp the extension, and remove the extension from the GT.
12. Wash and dry all equipment and supplies.
Tips for bolus feeding:
1. Feeding time can be adjusted based on your child’s tolerance. You can make the formula flow faster by raising the syringe higher in relation to your child’s stomach.
2. Try feeding more slowly if your child expresses nausea, stomach upset, or experiences loose stools immediately after feeding.
3. Feeding tolerance is best when your child is fed in an upright or elevated position and kept upright for 30 minutes after the feed.
4. If your child is sensitive to the cold temperature of formula, you can take it out of the refrigerator for a few minutes before a feeding.
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