Q At my hospital, we have a volume-based tube feeding practice. If a patient’s tube feeding rate is adjusted up and down to ensure delivery of the 24-hour volume, how do you control blood glucose level? This would be especially important in a patient receiving an insulin infusion with hourly checks of blood glucose level. Is the blood glucose level significantly affected by changes in the tube feeding rate? If so, do you find that the standard ordered insulin scales are adequate?

A Mary E. Lough, rn, phd, ccrn, ccns, replies:

Volume-based feeding (VBF) is a proactive approach to enteral nutrition delivery. VBF is nurse-driven and the goal is to provide 100% of the calories and protein needed via a feeding tube in critically ill patients receiving mechanical ventilation.

Heyland et al1  compared a VBF protocol with traditional enteral nutrition protocols in a multicenter, randomized, controlled trial in...

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