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by SouthernLPN2RN

If you have a residual that is well over 100, do you hold meds until the residual decreases? I'm just talking about meds given via the tube.

[meownsmile]

Re: Tube Feedings and meds

I would hold the med until i talked with the doctor. They would probly proceed with meds but have you hold the feedings for few hours. The patient might need some Reglan to help speed up GI emptying or they might do an obstruction series to make sure there is no illius involved.

[earle58]

Re: Tube Feedings and meds

i too, would hold meds.
check bowel sounds, abd distention and report findings to md.
monitor patterns: it can be an isolated incident or be indicative of something that warrants further intervention.
i learned that you normally hold fdgs when residual exceeds hourly rate.

leslie

[morte]

Re: Tube Feedings and meds

i have seen orders for twice the hourly rate,,,not in the elderly that i remember though

[SouthernLPN2RN]

Re: Tube Feedings and meds

I personally did hold the meds until the residual came back down. MD was aware of what was going on, but I was wondering what other folks would have done. Thanks!

[Tweety]

Re: Tube Feedings and meds

Our protocol is hold feedings for 1.5 times the rate.

If the tube feeding was running at say 80 or 100 cc/hr then 100 residual volume isn't anything. You and I might have that kind of residual volume when we take our morning meds with breakfast. Not a big deal and constantly holding until residual decreases deprives the patient of nutrition, if it's done at every med pass.

What is "well over 100"?

If the rate is 30 cc/hr. Then, yes hold.

Of course as Leslie stated there are other assessments that go along with it.

Your facility should have a written protocol somewhere. Check with your educator (which you may not have if you work LTC).

[SouthernLPN2RN]

Re: Tube Feedings and meds

Originally Posted by Tweety

Our protocol is hold feedings for 1.5 times the rate.

If the tube feeding was running at say 80 or 100 cc/hr then 100 residual volume isn't anything. You and I might have that kind of residual volume when we take our morning meds with breakfast. Not a big deal and constantly holding until residual decreases deprives the patient of nutrition, if it's done at every med pass.

If the rate is 30 cc/hr. Then, yes hold.

Of course as Leslie stated there are other assessments that go along with it.

Thanks Tweety! Our protocol is greater than 100. There were other issues as well, which I won't go in to right now. I think it makes more sense to use a protocol like yours.

[Tweety]

Re: Tube Feedings and meds

Originally Posted by SouthernLPN2RN

Thanks Tweety! Our protocol is greater than 100. There were other issues as well, which I won't go in to right now. I think it makes more sense to use a protocol like yours.

Yes, a rate-based protocol makes sense to me too.

[TheCommuter]

Re: Tube Feedings and meds

At the facility where I am currently employed, the standing protocol is to hold the feeding if the residual is greater than 150cc, call the doctor, and to document that you returned the stomach contents.