Checking Gastric Residuals in NICU

[NANSNURSE]

Just a question about checking gastric residuals...

I was just wondering if you check residuals and if you do, is there a rule about what size syringe you use.

I came from a unit that used to check them with a minimum of a 20 cc syringe (no 10, 5, 3cc, etc) But then that unit stopped doing it because the literature did not support checking them.

My new unit does check residuals, but I see nurses using 5cc and small syringes to check. I thought that the smaller syringes caused too much pressure.

I would love any input you all would like to share!!! Thanks!!

[RainDreamer, BSN, RN]

But what about the 2nd, 3rd, and 4th feeds?

We check placement before every feed.

[SteveNNP, MSN, NP]

Ah.... gotcha.

[RNSC]

But the wall of fustration comes when on the 3rd round checking placement, I get a 5cc residual for a baby that is getting 1cc q 3 hrs and and the residuals have been creeping up inspite of positioning, etc and you tell the resident and they say "Why are you checking residuals?" The attending on this month told me I should be able to check placement without aspiration. So I should leave the air bolus in? that sounds comfortable.

And how does the RN know that the stomach is emptying fast enough? Sometimes I get >50% residuals back with no outward symptoms. If I had no idea, and fed a full feed on top of it, the kid's either going to puke it all up, or start showing s/s feeding intolerance.