Bolus feeding is a type of feeding method using a syringe to deliver formula through your feeding tube. It may also be called syringe or gravity feeding because holding up the syringe allows formula to flow down using gravity. Most people take a bolus or a “meal” of formula about every three hours or so. This allows you to have more freedom in between feedings. A feeding will usually take up to 20 minutes.
You can also watch a video with our registered dietitian showing how to bolus feed:
To bolus feed, you will need:
- 60-milliliter (mL) catheter tip or oral syringe
- Cup of room-temperature water
- Formula
How to Bolus/Syringe Feed:
- Wash your hands.
- If you have a low profile feeding tube, prime the extension tubing to remove any air before attaching it to the feeding tube. Priming the tubing helps prevent air from entering your stomach and causing discomfort.
- Clamp the extension set.
- Remove the plunger from the syringe and attach the syringe to the extension tubing.
- Clamp the extension set.
- Pour about 15 mL of formula into the syringe.
- Unclamp the extension set, allowing the formula to flow just to the end of the tubing and clamp the extension set.
- Attach the extension set to the feeding tube.
- If you have a regular gastrostomy tube, flush your tube with water.
- Remove the plunger from the syringe.
- Attach the syringe to your feeding tube
- Pour 10-15 mL of water into the syringe and let it flow through your tube.
- Clean off the outside of your formula container with a clean towel and open it.
- Hold up the tube and syringe with one hand.
- Slowly pour formula into the syringe with your other hand. Allow it to flow by gravity into your stomach. It should take around 15 minutes to deliver 8 ounces of formula.
- Feed more slowly or more quickly depending on your tolerance.
- You can make the formula flow faster by raising the syringe higher in relation to your stomach or by using the plunger push the formula through.
- You can make the formula flow more slowly by lowering the syringe in relation to your stomach or by taking only ¼ or ½ of the can at a time with a minute or two in between.
- Flush your feeding tube with the amount of water recommended.
- Close the feeding port and disconnect the extension tubing (if applicable).
- Wash your hands.
- Wash and air-dry all equipment and supplies.
- Refrigerate any leftover formula and use within 24 hours.
Bolus Feeding Tips:
- To prevent infection, always wash your hands before handling the feeding tube, supplies and your skin.
- You should have better tolerance if you are sitting up during your feedings and for at least 30 minutes afterward.
- Cold formula may upset your stomach, so take it out of the fridge a few minutes before a feeding.
- You may need to slow down the formula if you start to feel nauseous or too full during the feeding.
- You may also need to feed more slowly if you experience stomach upset or loose bowel movements immediately after your feedings.
- Tap water is safe to use for most people. Ask your doctor if you need to use purified water.
For more information, see related articles and resources here:
- How to Use Your Child’s J-tube (Jejunostomy Tube)
- How to Clean ENFit Extension Sets
- Recorded Webinar: The Complete Nurse’s Guide to Tube Feeding
- Shield HealthCare’s Enteral Videos
- Tube Feeding My Child: What is the Safest Way to Handle the Bag Between Feedings?
Click here to watch the video:
Just brought my husband home from nursing home with G tube. Did my first bolus feeding without medical supervision. My husband weighs 268lbs. and I was instructed to give him 2 cans of supplement every four hours for three feedings and the last feeding just give one can. I was advised to flush with 200 ml. of water before and after feedings. This seems like a large amount of water as compared to what I have read on the internet. Plus I do flushing before and after his medication which I give him twice a day. Would appreciate your opinion about this.
Thank you.
Hi Jeanette, thank you for your question! Depending on the formula, your husband could be getting between roughly 1200-1400 milliliters of water from the formula itself. If you are adding 200 ml before and after each feeding (4 times) that adds up to a total of 2800-3000 ml in addition to what you use for medications. You can double-check with your health care professional that you are to add 200 before and after or just 100 before and after for a total of 200, but around 3000 ml of water daily seems about right for his weight as long as he is not on a fluid restriction per his doctor. This provides about 25 ml of water per kilogram of his body weight which falls in line with what is recommended. Of course it wouldn’t hurt to run it by his doctor just to make sure the instructions were interpreted accurately.
I am taking my Dad off the pump and going bolus. I am doing 250 ML/375 calories every 4 hours. Then on top of that the Dietitian told me to give 1500 ML of water. He is Bedridden. 92 years old. So id I do these at 11/3/7/11 then take him completely down off nutrition at night for 12 hours? Then can I give him the majority of the water over night? We give him med or water every 4 hours…Does that all sound right?
Hi Lorri, it sounds like you are very organized and taking great care of your dad! As long as your are giving some water before and after his feedings to keep the tube unclogged…if the overnight water doesn’t cause any incontinence issues that should be fine. If you end up with accidents, you might want to see if you can split the water throughout the day. For example, you could give 185 ml before and after each feeding 4 times daily to pretty much meet the 1500ml. This may also be easier because you won’t have to worry about giving water at night. Hope that helps!
Is it ok to do meds during the feeding? Or at the same time?
Great question, Sandy! In order to prevent any interaction between medication and formula, it is advised to stop the feeding and flush your tube with water before administering medication. After the medication, you should flush the tube again. Then you can resume feeding. A clogged tube can be related to medication and formula coming in contact with each other.
Hi. My 13yr old son has a g-tube since birth. We are tubing bolus with 50% blender and 50% pediatric soy (Bright Beginnings). For breakfast, lunch and dinner we tube ~150mls over 10minutes, wait 10minutes and tube another 150mls. We also have another 210mls we tube at night. He seems to get pretty tired after the tubings. I’m just wondering if this is related to volume or rate of the feedings. I googled this and couldn’t find anyone discussing lethargy w/rate and volume. Any advice is greatly appreciated. Thank you!
Hi Dana, thanks for your question! I wonder if the size of his meal his making him sleepy. You could try splitting his daily intake into 4 feedings and see if that helps.
We feed our mother via bolus feeding through a g tube. We flush before and after, of course. When we pour the formula in, it goes in so slowly that we have to ‘chase’ it with a little water each time. Would it be ok to mix the formula in the beginning with some water in a measuring cup to thin it a little to hasten the flow into the tube? We would still flush before and after. Thanks for any info.
Hi Carol, thank you for your question! Some formulas are a little thicker than others, especially if they contain fiber or are concentrated in calories, such as those that are 1.5 to 2 calories per milliliter. As long as you are administering the formula with water immediately and it’s not sitting around, it should be okay to add some water to the syringe to thin the formula a little. You can also count the water you use toward your flushing water so you end up with the same amount of water each day.
My husband gets 6 cans of Jevity 1.5 daily plus one bottle of Ensure with protein. We have him on 3 feedings of 2 cans a day but with our schedule we are wondering if we could go to 2 feedings of 3 cans each? Thank you for your help
Thanks for your question, Arlene! It all depends on his tolerance. You could increase each feeding gradually to test it, for example start out with 2.5 cans at each feeding and see how he feels. If after a couple of days he doesn’t have any discomfort, nausea or loose stools, you could try 3 cans. That said, it’s probably better for him to stay on the 3 feedings because it spreads out his calorie intake to help regulate his metabolism. If you absolutely need to reduce the number of feeds to 2 per day, maybe you could still do the 3 feeds a day on some days, alternating between the 2 schedules. Hope that helps!
My husband is age 77 , bedridden,has dementia from closed head trauma due to accident in Navy. I feed him via a PEG tube. For years we gave Jevity 1.5 three times a day via Bolus or pump. A nurse suggested we switch to Two Cal HN twice a day. I believe he has lost weight on the Two Cal. He is 6’2″ weighs 139 lbs. When we feed and the amount of water given is in direct correlation to the suctionings due to phlegm in his throat. Bolus is 60ml water before, 60ml feed, 60 ml after. We wait 1 to 2 hrs between feedings until the 237 ml can of Two Cal is gone. We give 2 cans a day. Is that enough feed and are we giving the feed and water too fast and too often?
Hi Mary, thank you for your question! With the difference in treatment plans you mention, there is a deficit of 115 calories daily. Over time this could have led to weight loss. Was there a specific reason the change was made? He is also getting significantly less fiber. How are his bowel habits? Regarding the timing of his feedings, I’d recommend waiting 2-3 hours between each can of Two Can HN as it’s pretty concentrated. For more calories, you could add an additional half-can of the Two Cal HN in another feeding or you could try going back back to the the 3 cans of Jevity 1.5. Another option would be to syringe in a liquid protein supplement, such as Promod, which would contribute an additional 100 calories and 10 grams of protein.
I watch a 18 month old with a Mickey button. I’ve never been trained, and can only go by what his mother has showed me. All his fluids are given through his tube, but he consumes most food orally. We give him 4ozs of pediasure at a time, every 3-4 hours. I was taking my time pushing them, but his mom just pushes it all straight in, in a matter of about 2 minutes. I started doing this as well. Is this safe? It doesn’t seem to bother him, but a client of mine, who is a nurse, seemed concerned. I just want to make sure, I’m not doing anything to harm him. Thank you in advance!
Hi Heather, thanks for your question! It’s hard to answer without knowing anything about the child but if he tolerates it it’s probably okay. Watch for signs of intolerance, such as nausea, vomiting, abdominal distension or fussiness.
My mom 93 years old was order 40cc of g-tube feeding . The Kangaroo feeding machine was ordered. The machine arrived and the hospital expected the private CNA to assemble. The machine ended up having to be replaced three times within 48 hours and wasn’t utilized. The nurse cane out and gave my mom 300 cc through via Bolus at one time . The next day 200cc although the doctor ordered 40cc per hour. A week before she had fluid removed from her lungs and scar tissue had developed.
Finally the machine was operating but the less than 18 hours the bag oh of 1000 was empty and my mom’s Breathing , oxygen and heart rate changed. Rushed her hospital discovers fluid had build up again in her lungs. I believe it was from the Bolus feedingof 200-300 at on time which created more fluid. I am seeking answers as we speak. She’s in the hospital now.
I am unclear what to do but I believe both times the Bolus created the problem.
Hi Jane, I’m so sorry to hear that happened to you and your mom. The additional fluid buildup in her lungs was probably more related to her medical condition than the feeding, but her pulmonary doctor should be able to explain the situation. Our thoughts are with you, I hope she gets better!
My husband has just been given a gtube still in hospital. Is there any advice on feedings as I’m very uncomfortable at the moment & not sure can do this.
Hi Charlotte, thank you for your question! Caring for someone at home with a feeding tube can seem daunting at first, but it’s something you can definitely get the hang of. Start by watching everything the nurses do when they administer your husband’s feedings, ask questions and write things down. Make sure they send you home with written instructions for the feeding plan, including water flushes. Choose a medical supply company that has a registered dietitian. Read up before he comes home. Here are some articles to start with: How to Prepare for Home Tube Feeding, Enteral Nutrition Overview, Shield HealthCare’s Enteral Videos. In addition to support from your healthcare professionals and medical supply company, check out the Oley Foundation for information, tips and support from others who care for someone with a tube or who have a tube themselves.
My 37 year old daughter, Natalie, was born with severe cerebral palsy and is now a 100 pounds nonverbal quadriplegic. She has had a gtube for 3 months and we are still trying to adjust her feedings so my husband and I can sleep through the night. Jevity upset her stomach in the hospital, so they changed her to Vital. She was prescribed 5 Vital cartons along with 900ml water daily. We have tried 3 feedings of 1.5 cartons of Vital along with 300ml of water. Testing for residual dictates we must wait 6-7 hours between feedings. Natalie requires miralax, dulcax, and fleet enemas for her bowel to act every other day. Her abdomen remains distended. I am so frustrated and worried I am not doing what is best for Natalie! I would appreciate any suggestions! Please help me!
Hi Janice, I’m sorry you’re having trouble. I have lots of questions to to try and get to the bottom of this. Is your daughter on anything for gas? Ask her doctor if this might help. Is she having regular soft bowel movements? If not, maybe her bowel regimen needs to be adjusted. What amounts are you pulling out when you check residuals? If it’s a small amount you might ask her healthcare professional if you can stop checking residuals and spread out her feedings more. Is her abdomen distended all the time or just after feedings? How long does it take you to administer each feeding? It’s possible you may need to slow down the feeding. For example, if you’re using the plunger to push formula in through the syringe, try removing the plunger and pouring formula in to the syringe slowly, allowing it to flow by gravity. The higher or lower from her stomach, the faster or slower it will go. If you’d like to discuss further, please email me at rd@shieldhealthcare.com. You might also check in with the doctor to see if she needs to be seen or change something about her medication regimen. Thank you!
I am a support worker and have a client who is gravity peg fed…. what is the most amount in volume of liquid that he should be getting… as on previous occasions he has vomited when getting too much.. he usually has 300ml fortisip and 100ml flush which he takes fine but when including medication, it is taking him well over 500ml..and I have noted he will hold his breath or start hiccuping.. I would like some advice if possible
Hi Lynn, thank you for your question! The total fluid he needs daily depends on several factors, such as weight, age and medical conditions. The amount he can tolerate at one time probably varies but you can think about it like this: 500 ml is 16 ounces or 2 glasses of water. Most people might not feel great after downing this amount of liquid quickly. If it seems like he doesn’t tolerate this amount, try breaking it up into 2 servings a few minutes apart.
my mom is 81 had stroke 3 years ago, has had g tube that I flush meds and water. Recently had aspiration pnemonia and is npo and is on antibiotic taking 3 x day and giving ensure plus 1 1/2 can in am 1 can at 1pm and 1 1/2 at 6pm is still having very loose watery stools about 1 hour after ensure. She was eating before this happened (modified). She is non verbal so it is hard to know can I flush a pureed bannana in with ensure maybe it will help and other foods if goes through tube?
Hi there, thank you for your question. Most likely, the antibiotic has something to do with her loose stools. It’s a good idea for her to be on a probitoic supplement at this time and especially after the antibiotic is finished, to help maintain the good bacteria in her gut. It may also help prevent antibiotic-associated diarrhea. In addition, some people don’t tolerate Ensure/Ensure Plus well through the feeding tube, as these formulas are made for oral use. You could ask her doctor about trialing a different formula, such as Jevity 1.5, which has about the same calories per can as the Ensure Plus. You might also make sure she’s not getting her feeding too fast – try to take around 15 minutes for each feeding.
I have had a PEG tube for 4 weeks. I gravity feed through bolus. Recently I have used it less because I’m starting to swallow again but I still need the formula feed for nutrition. I’m now discovering that gravity is just trickiling in. When I tried to flush with water, much of the water came right out through the stoma. What’s going on?
Hi Kris, it sounds like you may have a clogged tube. This may have happened as a result of using your tube less often – congrats on starting to swallow again! If more than a couple hours goes by without using the tube, it’s a good idea to flush some water through. Here is a video with article about how to unclog your tube: http://www.shieldhealthcare.com/community/nutrition/2015/12/03/tube-feeding-how-to-unclog-your-feeding-tube-video/. Try this method a few times (some people even let the water sit in the tube for an hour or two) and if you still are unable to unclog the tube, you may need to call your gastroenterologist or healthcare professional. They may have access to a mechanical or enzymatic method of unclogging the tube. Best of luck!
Hi I have been on feeding tube for more than 7months now I have a obstruction from stomach so I am placed with a jejunostomy tube 200ml of feed for every 2hrs and 50cc of water I have lost more than 30kilos of weight I was 70+ now am like 38 I left with only bones is it normal or am I having any problems. Am from India my doctor doesn’t seem to care as I feel nauseous when taking the feed and after being feed I start to sweat and feel like having a blackout and yes I am having this blackouts for a while now even if I feel slightest pain or walk for while do a little work I blackout and regain consciousness after a while due to this am restricted to home. Am one more concern I have lost almost all my hair Iam going bald it’s like hair fall in chemo patients is this due to my feeding will I gain hair back or will this be permanent please tell me
Hello, I’m sorry to hear you are having trouble. Most people with a J tube (jejunostomy) are fed via a feeding pump at a slower rate. If you are unable to tolerate the current regimen, it may help to slow the rate and feed for a longer length of time. If that doesn’t help it may help to try a different formula. If your doctor is unable to help you, can you get a second opinion or seek a referral from a specialist in gastroenterology and/or tube feeding or oncology? A dietitian may also be able to help you adjust the rate. If your doctor is unable to recommend, the medical supply company that provides your feeding supplies may have access to a dietitian. If you’d like to discuss this further, please email me at rd@shieldhealthcare.com.
Hi there! Just a quick question. I am a Direct Suppotive Professional now for a little over a month. In using the Bolus method in GTube feeding with my client, I wanted to know, how fast or slow should I pour water and how important is it for a 10cc..water to reach its mark? Example, when I pour 10cc to flush, if I go a little over 10cc or a little below, is that okay? Please help me to understand.
Hi Tonya, thanks for your question. The speed at which you deliver water depends on your client’s tolerance. If you’re only pushing in 10cc you should be able to do that pretty quickly. Whether or not you need to be exact in measuring the 10cc also depends on your client’s medical condition but you’re probably fine going slightly under or over if you’re having a hard time assessing exactly 10cc.
If im not feeding how often should i flush with water
Hi Linda. Thank you for your question. To answer, we’re going to reference a previous comment you can find above by RD Amy Carrera: “If more than a couple hours goes by without using the tube, it’s a good idea to flush some water through.” We hope you find that helpful. Please let us know if you have any other questions. Thank you. -Aimee, Shield HealthCare
Hi there
Just stumbled upon the site and hope you can help!
My toddler has had a gtube pretty much since birth. While in the nicu she developed several severe cases of distention. At the time, we thought it was the formula, so we changed it.
Ever since, we’ve been dealing with her forceful regurgitation/reflux now with no cause or end in sight. She has not had any distention but I believe the pressure from the gas buildup is what’s causing the reflux.
I try to release some of the gas by venting; I secure an empty extension set & syringe to her mic-key, stomach fluids/formula comes up and so a lot of gas.
Is there a better way to let out the gas?
At the hospital, they elevated an empty syringe to vent it but at home that doesn’t work; I need to lower the syringe below her button to get anything to come out.
What’s the best way to vent? Is it possible to reduce air/gas buildup during her bolus feeding? I use the pump occasionally and that did not reduce the gas buildup.
Hope you have answers that can help.
Thank you
Hi there. Thank you for your comment. We spoke with one of our registered dietitians, Mary, and she said: “I would recommend that she discuss the option of using a Farrell Valve Bag Pressure Relief System with her child’s gastroenterologist.” We hope you find this helpful, and please let us know if you have any other questions. -Aimee, Shield HealthCare
After 4 hours , we check the content in my sons stomach / for days it has been 180 to 200 …he is suppost to do a feeding ever 4 hours , is there a reason that so much is still in his stomach and what should I do …this just started happening a few days ago …all was ok before
Hi Nan,
Thank you for reaching out. We hope to help you and your son as much as possible! We spoke with one of our RDs, Cassandra. She says, “As of right now, the Academy of Nutrition and Dietetics encourages holding tube feeds only for signs or symptoms of intolerance (i.e. pain, nausea, vomiting, constipation and/ or abdominal distention. If signs of intolerance are noted, I would encourage you to stop enteral feeds and contact a physician. It is normal for the stomach to contain gastric secretions and contents of enteral formula, however tube feeds should not be stopped for residuals less than 500ml. If aspiration is a concern, continue to make sure head of bead (HOB) is greater than 30 degrees during enteral feeding. And, as always, follow instructions per physician recommendations and follow up if there are any uncertainties regarding feeding.” We hope this helps.
Best Wishes.
Sarah, Shield HealthCare
My brother has CP with swallowing issues and now at 74 needs a feeding tube . . The Dr. recommended at j tube to minimize aspiration issues . . The home where he lives only does Bolus feeding but the Hospital says he must have an automatic pump . .is there an acceptable way to feed him manually through a j connection ??
Hi Jerry. Thank you for reaching out. We are sorry to hear about this issue. The best advice would be to contact his doctor right away for a new feeding plan so he can be safely fed at home.
-Sarah, Shield HealthCare
How do you do the residual check before syringe tube feeding?? Is there a video showing how to do that? Thank you in advance for your answer.
Hi Glenda. Thank you for reaching out with your question. I consulted our team of RDs and received the following advice:
Basic steps for checking residuals
• Place a 60 mL syringe without a plunger into the G-tube.
• Lower the syringe off to the side, below the stomach level. Put the open end of the syringe into a cup.
• Watch as the stomach contents flow out of the G-tube and into the cup. When the flow stops, measure the fluid.
This can also be done with the plunger in the syringe, gently pulling back to accumulate the residual for measure. (See video)
I hope this helps!
Hi. I just brought my dad home from the hospital with a g tube. They have him feeding 265 ml of glucerna 1.5 at 7 am, 12 pm 4pm 8pm and midnight with 100 ml before and after Bolus. Is there a way to get all this done between 7 am and 8 pm?
Hi Diane. The treatment plan established for your dad is based on what is best for his nutritional needs and tolerance. It is important to follow the treatment plan prescribed by his doctor. If you have any concerns regarding the prescription contact his medical team before making changes to his treatment plan.
Hi, my mom was on a gtube and the weekend nurse at a rehab hospital injected her with what seemed like a ton of glucerna all at once. She immediately began to vomit and aspirate( shes a sepsis survivor and was on a ventillator and then had a trach). What went wrong?
Hi August. It is important to discuss this with your mom’s doctor as soon as possible.
Hi my mom just got home with the peg tube. How much do I pull back on the syringe when doing the residual check before feeding? Do I keep pulling until nothing comes out?
Hi Veronica.
It would be best to reach out to your mother’s doctor as they will be able to better guide you through residual checks and what to expect when caring for the peg tube.
The best of luck to you and your mom!
-Sarah
I had a g-tube inserted 1month ago. I’ve had pneumonia and spent a few days in the hospital. I am having trouble staying hydrated and feel bad even after IV fluids. I am at my wits end. I don’t see how this is working. I am on a pump feed @ 65ml hr with 105 flush per hour. I am able to eat and after a meal my stomach hurts and is distended. I am also an Ostomy patient My pain has been constant since having the g-tube placed but they’ve checked the tube and it’s in the right place.
Hi Laura.
We are very sorry to hear about the discomfort you are experiencing. While it can be normal to feel some, it is understood that the pain you are in is extreme. Follow up with your doctor as soon as you can and explain the pain you are in. Also, it would be a good idea to get in contact with a Registered Dietitian to aid with your nutrition plan. Your medical team should be able to connect you with an RD in your network.
We wish you the best and hope you feel better soon.
-Sarah
My son 26 yrs old with gt feeding since 4 yrs old. Got GI bleeding last July. He is on Nutren 1.0 3 bricks a day. Can his formula be change since his iron is low? And if new formula will be coverd with medical insurance.
Hi Evelyn.
We are sorry to hear about your son’s GI bleeding. This is a good question and I’m glad you reached out. Yes, there may be other formula options for him. Check in with his doctor to find out which formula will help your son meet his nutritional needs, including his increased iron needs. His doctor and your medical supplier will also help you determine what is covered under your medical insurance.
-Sarah, Shield HealthCare
Hubby is NPO. NEEDS 5 CARTONS OF GLUCERNA A DAY. I DO BOLIS FEED. Aside from his liguid feed how much water should he get a day? Seems we have a real hard time keeping him hydrated. He weighs 142 lbs.