Any time you should NOT check for residuals with a PEG?

[uswoman]

Hi! I'm being "called on the carpet" by dieticians who say it is not necessary to check residuals before a bolus feeding through a PEG tube. A bit of background: critically ill 38 year old, bedbound, with liver failure amoung his many problems, as well as gastroparesis. The patient was being prepared to return to live in a group home with NON-SKILLED caregivers, so I taught them to do this before each feeding. (As well as the other precaution of having the head of the bed elevated.) A couple of the caregivers were really onto learning all this and doing it right, but a couple found it was a huge bother. (One even said, "Why are you putting all this extra work on me?" when I showed her how to aspirate the tube!) I was also concerned because the dieticians had increased the volume at each feeding and one of the better caregivers told me he vomited after he was given that much and she wondered why they did that instead of doing the smaller more frequent feedings he had been on. (To further explain, he was in a larger hospital and we had him in a small rural hospital closer to home. The dieticians are all at the larger hospital and "far too busy" to actually come up to our little hospital.)The dieticians made this change right before he was transferred to us. So, with this caregiver, we wrote out a schedule for his smaller tube feedings and medications and it worked quite well to keep them and the nurses on the same track.(Same feeding solution and same volume). Anyhow, I still maintain that I am the one at the bedside giving or ensuring the safest care possible is rendered, not the dieticians. And, all this has come about months after the patient died - and it had nothing at all to do with his tube feedings!

Any references would be greatly appreciated!

[morte, LPN, LVN]

as far as i can figure, it is NOT up to the dietician if you check residual or not......that is a nursing/md issue.