I have a random question about a situation that once happened to me in clinical during nursing school (I'm preparing for interviews and polishing my stories from all of my clinical experiences!). I once pulled out over 1200cc's of gross looking brown liquid of gastric residual from a patient on a med/surg floor...the doc was called and, contrary to my instructor's desires, ordered that the fluid be discarded because it looked "yucky." The patient's pressure later bottomed out (not sure what happened after that because I left for the day). As a nurse, would you have also disagreed with the doctor's decision to dispose of the residual? When is it appropriate to replace/discard gastric residuals for adult patients?
Thanks in advance for any help/advice
May 20, '12
by Esme12, ASN, BSN, RN
On a Med surg floor I'll bet this was an NGT insertion to check gastric contents for hemoccult as is often the case for the suspicion of GI bleed and to facilitate gastric decompression/emptying. Was there an feeding being infused? How fast was it going? If so when was the last time someone checked for residual.....that's a boat load of residual. I'll Bet this patient had gastric distention ( a huge belly with pain) and this was done for decompression.
I am not sure what your instructor was thinking for I would not put it back 1200cc of anything brown and gross. That does not belong returning to the abdomen and is no longer considered "residual" but gastric contents/output. 1200 cc's of Copious Gross brown gastric output would have made me suspicious of GI bleeding....it is something called coffee ground gastric contents..I would have called the MD. Prepared for an IV for I am suspicious for bleeding and the hypotension that will follow and prepare the patient for lab draws and type and screen for blood products. I would hemoccult/guaiac the contents to check occult blood and make the patient NPO.
We discard all adult outputs with the exception of tube feeding gastric contents < 250cc's.. If we do save contents it is in a small container to "show" to the MD and/or send a sampling to lab for testing. If this patient was being fed......I would stop the feeding.
I hope this helps.
Last edit by Esme12 on May 20, '12