PEG Residual: risk for aspiration?
- 0Nov 8, '08 by sjoubert001I'm a med surge 1 student. I had a patient with a newly placed PEG tube the other day, I check for placement injecting 30 mls of air and listened for the sounds. I also checked for risidual, I pulled out 50 mls of gastric contents. There was an order to increase the patients feeding by 10 mls every q 6 hrs, the patient was getting 10 mls/hr, I with the assistance of my instructor increased the feeding to 20 mls. Was my patient at high risk for aspiration, concerning the residual of 50 mls?? This is probably not a great question to be asking ... being that I'm probably suppose to know the answer but I would greatly appreciate some feed back.
- 2Nov 9, '08 by TweetyWelcome to Allnurses. Since you are asking a question....a very good question...I'll move this thread to the General Nursing forums.
50 cc's of gastric residuals is actually not that much. At any given moment you and I could have that much in our stomachs. You were correct in continuing to increase the feeding. I'm not sure however at what point we would not increase the feeding. Usually there's a doctors order such as "hold tube feeding for residual of 100 cc or more" or something like that. Once a tube feeding is at their goal rate the policy where I work is if the residual volume is greater than 1.5 times the rate of infusion, then we hold.
Persons with tube feedings are aspiration risks and should always have their HOB up 30 degrees, so you're wise to keep that in mind at all times.
Good luck to you in school and beyond. I hope that you stick around the forums.
- 1Nov 9, '08 by leslie :-Dconsidering this pt had 50cc of residual and was recently increased to 20cc of fdg/hr, honestly, i would have questioned it as well.
yes, aspiration is always, ALWAYS a risk.
hob up, as tweety said.
and for the future, 30cc of air is not necessary to check placement.
you can easily check w/10cc.
all that air entering the stomach, is so uncomfortable for the pt.
good luck with your studies.
- 2Nov 9, '08 by cherrybreezeWith surgically placed J-tubes, you do not need to check placement; anything else you do, and that includes PEG tubes (they CAN migrate). 10 ml of air should be enough, 30 ml is a lot.
Our protocol states to hold feedings for more than 150 ml of residual. Of course, if your judgement would give you any reason to believe you should hold it with less (feeling of discomfort, bloating, nausea, whatever), do so, but I know that 150 is our "magic number," so to speak.
- 0Nov 9, '08 by sjoubert001Quote from CHATSDALEThere was no order saying to hold feeding if there was x amount of residual, I found that kind of odd. I dont find that there was much resistance when I aspirated. My instructor told me that it was ok to increase the feeding. I trust her judgement, but at the same time I was kind of doubtfull.was there an order to hold feeding if the aspirated amount was greater than a specified amount?
what did your instructor say when you aspirated 50cc? was this a 50 cc syringe, was there a resistance in the last few ccs?