Dietetic attitudes and practice towards bolus feeding

Abstract

Bolus feeding is the administration of feed to a patient as a series of smaller volumes of enteral nutrition given at regular intervals via an enteral feeding tube.⁽¹⁾ It is currently estimated that approximately 2,000 people are receiving home enteral tube feeding (HETF) in Ireland.⁽²⁾ However, there is limited evidence surrounding the use of bolus feeding in enterally fed patients.

The aim of this study is to investigate Irish dietitians’ attitudes and usage of bolus feeding in their adult patients.

Survey Monkey was used to create an eighteen-question survey which was distributed by the ‘Irish Nutrition and Dietetic Institute’ in their online newsletter and the ‘Irish Nutrition Jobs’ Facebook page. Descriptive statistics were performed using IBM SPSS® v27 to determine percentages. Dietitians that worked with adult patients and reccommended bolus feeding to patients were eligible to take part in the survey.

Out of 100 respondents, 74 dietitians fit the eligibility criteria for data analysis. Of the 74 participants recommending bolus feeding in adult patients, they primarily worked in hospitals (64%, n = 47) and in the community (35%, n = 26) with 20% (n = 15) specialising in oncology. Just over half (58%, n = 43) of dietitians agreed that the number of patients being bolus fed has increased over the last 5 years with 26% (n = 19) reporting that more than half of their enterally fed patient case load receive bolus tube feeding. The majority of dietitians (99%, n = 73), routinely use the syringing method when administering a bolus feed.

Dietitians commonly recommend bolus feeding in oncology patients (65%, n = 48), those with neurodisability (46%, n = 34) and in adults with gastrointestinal diseases (19%, n = 14). When choosing to administer a bolus feed, 53% (n =39) of dietitians aim for 400kcal per feed, with 200ml ONS being the most popular bolus feed format (62%, n = 46). Almost all dietitians (96%, n = 71), decide to use bolus feeding with their patients as it suits their lifestyles as well as 81% (n = 60) reporting that it is favoured for its convenience.

Many of the dietitians (61%, n = 45) are of the opinion that feeds designed in a format for bolus feeding would improve patient experience. To further improve their training, dietitians reported there is a need for additional practice guidelines (47%, n = 35) and practical workshops (46%, n = 34) on bolus feeding.

This study found that dietitians are recommending bolus feeding for patients more often in the last 5 years (2019-2024). Participants reported that bolus feeding suits patients’ lifestyles as it’s convenient and it suits their social circumstances. There is a need for a specific format for bolus feeding products as well as specific bolus feeds to improve patient experience. Dietitians agree that additional resources such as practical workshops and guidelines are needed to further support them with bolus feeding.