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Supplements (glutamine and protien) are not routinely added to feeds unless specified by dietitian. Food services will supply the supplements in a labeled 60ml syringe(s), label will state supplement name, concentration and patient's name.

Protien supplements are usually ordered for patients with high protien requirements (eg. high catabolic patients, one example are burn patients).

Glutamine supplements are essential for the maintenance of the bowel mucosa; without it, the bowel can degrade and bacteria can translocate. Glutamine supplements may prevent future infection.

Supplements will be given per the following schedule;

OD- 1000

BID-0800 1700

TID-0800 1200 1700

QID 0800 1000 1400 1700

Nurses will administer the supplements as boluses per the following routine:





Obtain Supplement

Ensure the order on the chart is correct with what is transcribed on the patient's MAR. Ensure corrrect patient with correct supplement when obtained from refridgerator in nutrition area.


Ensure correct patient with correct supplement against physician order, as it is manually transcribed on the MAR by nursing. Nutritional supplements do not have a DIN (drug identification number) so pharmacy cannot place it on the computerized MAR.


Prepare supplement

Remove the supplement from the refridgerator 15-30 minutes before administion time. This allows supplement to come to room temperature.


Cold solution may cause abdominal cramping.A room temperature supplement is also less viscous so it is easier to administer.


Hand Hygiene

Perform hand hygiene and don non-sterile gloves.


In accordance with the MoHLTC 4 moments of hand hygiene and LHSC infection control policies in an effort to reduce risk of transmission of microorganisms and secretions.


Draw up Flush

Draw up 60 mls of sterile water into a 60 ml catheter tip syringe. Instill 30 mls of sterile water into medication/bolus port of the feeding tube. Detach the syringe.


Flushing the feeding tube helps maintain patency.

Catheter tip syringes are recommended to avoid inadvertent IV administration orally/enterally which can happen with luer lok tip syringes.


Instill Supplement

Attach the supplement syringe to the feeding tube,and instill supplement.




Post Flush

Attach the remaining 30mls of sterile water flush to feeding tube and flush.

Remove non-sterile gloves and perform hand hygiene.


Flushing the feeding tube helps maintain patency.

In accordance with the MoHLTC 4 moments of hand hygiene and LHSC infection control policies   in an effort to reduce risk of transmission of microorganisms and secretions.



Document on the MAR with your initials that supplement was given. Document fluid amount of supplement and flush on the MAR.


To verify supplement(s) were given. To accurately document on the intake and output record.


Disposal of Syringe

Dispose of syringe labeled with patient's name in the white Rx bucket located in each patient's room.


To ensure patient confidentiality, all labeled medications must be disposed of in white Rx bucket to ensure they are disposed of correctly to ensure patient confidentiality and privacy.


ICU procedure for the administration of nutritional supplements by Mary Beth Billick and Rachelle McCready, June 2006.

Reviewed by;

Susan Smith, RD,

Mary Donnely Vanderloo, MSc, RD

Gina Souliere, RN, BScN

Last Update: April 15, 2010. .