[RainDreamer]

Originally Posted by RNSC

We just started this in my unit and its making me a little crazy. It seems to go against common nursing sense. As LittleneoRn said a small bilious residual sometimes is the first subtle sign that you get. I know what the studies say but my experience is different.

Like I said, you know if there's bilious residual when you check placement.

[SteveRN21]

Originally Posted by RainDreamer

Like I said, you know if there's bilious residual when you check placement.

But what about the 2nd, 3rd, and 4th feeds?

I agree with being able to assess for bilious residuals at the outset of the shift, but residuals are an integral part of monitoring gastric emptying and overall feeding tolerance. We advance feeds taking residuals into consideration.

And how does the RN know that the stomach is emptying fast enough? Sometimes I get >50% residuals back with no outward symptoms. If I had no idea, and fed a full feed on top of it, the kid's either going to puke it all up, or start showing s/s feeding intolerance.

When we start seeing loopiness, full abdomens, etc, the residuals over the last shift are usually taken into consideration when deciding course of treatment. The same for increased/bilious residuals alone, it helps us anticipate tx, and more closely monitor for further intolerance.

[RainDreamer]

Originally Posted by SteveRN21

But what about the 2nd, 3rd, and 4th feeds?

We check placement before every feed.

[SteveRN21]

Ah.... gotcha.

[RNSC]

But the wall of fustration comes when on the 3rd round checking placement, I get a 5cc residual for a baby that is getting 1cc q 3 hrs and and the residuals have been creeping up inspite of positioning, etc and you tell the resident and they say "Why are you checking residuals?" The attending on this month told me I should be able to check placement without aspiration. So I should leave the air bolus in? that sounds comfortable.

And how does the RN know that the stomach is emptying fast enough? Sometimes I get >50% residuals back with no outward symptoms. If I had no idea, and fed a full feed on top of it, the kid's either going to puke it all up, or start showing s/s feeding intolerance.