I had a pt. tonight with a peg tube and nutren pulmonary running continuously at 60cc/hr. When the residual was checked it was 300cc. I turned the kangaroo pump off and notified the MD. Now i was taught in school that you should always replace the residual that you pull out because the digestion process has already begun and your body has already broken the nutrients down and what not. The charge nurse said "absolutely not" you should always discard a residual that is that great. I talked to a few older nurses as well, and they agreed. I talked to a couple newer nurses and they also said that you should replace the residual. I dont know if this is a new thing or I just got it wrong in school, but it would make sense to me to replace it. The charge then called the doc and he told her it was fine to discard the residual. Which is fine because that is an order. If anyone has advice it would be helpful.
If I have a residual of greater than 4 times the rate at which the tube feeds are infusing, I shut the pump off for an hour and discard half of the residual. Thats what I was told at my last job. My book says to readminister it but if the patient has been vomiting, their abdominal girth has increased, I'm not putting it back.
Last edit by RN1982 on Dec 21, '08