checking for residuals

decartes · Aug 22, 2006

That sounds about correct.

When you force anything, you can do damage hence, don't force it.

Gompers, BSN, RN · Aug 22, 2006

Yep, pull back until you feel resistance and there is no more air or residual coming back into the syringe. Don't force it, and if you're worried, "pulse" it a little so you're not putting continuous suction on the stomach wall.

I've seen more damage from placing NG/OG tubes or from having tubes in to continuous wall suction than I've ever seen from aspirating residuals. If you're seeing flecks of blood in the residual, it's more likely that it's from the pressure of the tube sitting against the stomach wall, not you.

RainDreamer, BSN, RN · Aug 22, 2006

I agree with the above. If you're going to get any residual back, it should just come right back, without any force.

Sorry this is a little off topic, but sorta along the same lines ....... do most units check residuals before each feeding?

We aren't supposed to check residuals anymore, as long as there are no changes in the baby's belly (it's still soft, no increase in girth, etc) and the baby isn't spitting or having any other symptoms of intolerance. Unless they write an order for residual checks, we're not supposed to check them.

It's hard to break that habit of checking residuals. They just changed this policy though about a week after I started on orientation, so it hasn't been hard for me to break a habit of it, since I never really had the habit in the first place! But obviously, for some of our nurses, it's almost like second nature to check the residual.

It's no big deal if we do check them, but if we get a residual back, and we inform the doc ... they usually just have us feed, as long as the baby isn't having symptoms of intolerance.

Just curious as to what other units do.

Gompers, BSN, RN · Aug 22, 2006

I agree with the above. If you're going to get any residual back, it should just come right back, without any force.
Sorry this is a little off topic, but sorta along the same lines ....... do most units check residuals before each feeding?
We aren't supposed to check residuals anymore, as long as there are no changes in the baby's belly (it's still soft, no increase in girth, etc) and the baby isn't spitting or having any other symptoms of intolerance. Unless they write an order for residual checks, we're not supposed to check them.
It's hard to break that habit of checking residuals. They just changed this policy though about a week after I started on orientation, so it hasn't been hard for me to break a habit of it, since I never really had the habit in the first place! But obviously, for some of our nurses, it's almost like second nature to check the residual.
It's no big deal if we do check them, but if we get a residual back, and we inform the doc ... they usually just have us feed, as long as the baby isn't having symptoms of intolerance.
Just curious as to what other units do.

We normally check them. Sometimes the doc writes and order to NOT check them and to feed "as tolerated" instead. These are for babies on continuous feeds - who will always have a residual - or tropic feeds. I think we're heading in the direction of not checking at all.

Mimi2RN, ASN, RN · Aug 23, 2006

Checking for a residual is another way of checking placement. If you get no residual, and there is a different "feel" when you draw back on the syringe, your tube may be in the wrong place. The next thing I do is untape and insert the tube a little further in, and draw back again before I retape. I've been surprised when I find that the baby who has had no residuals suddenly has several ml's still in there......

NiteRocker · Aug 23, 2006

I'm in a surgical NICU, so we check residuals q 4 hours unless it's trans pyloric placement. We only hold/call if it is 2x hourly rate. Often, emesis will follow the replacement if it was large and returned to quickly. The amount and character are important in the surgical unit.

RainDreamer, BSN, RN · Aug 23, 2006

We're a surgical unit too, do all our own surgeries. Obviously on a gut baby that's starting feeds we'll check residuals (they write orders for it), but I was just wondering, in general, if most units still check residuals .... even if the kid has no gut issues.

Gompers - That's how it started out for us. So often the docs were having to write orders to NOT check residuals. So I guess it just made sense for them to change the policy and have the docs write orders FOR residual checks instead.

prmenrs, RN · Aug 23, 2006

Some older "gut" babies, the surgeon would tell us, check for residuals IF YOU MUST!, but DON'T CALL ME! (Her emphasis, not mine!)

I took care of twins this weekend who were borderline feeders. (My favorite 35 weekers!) They would only nipple part of the feeding, if @ all; before I gavage the rest, I like to see if there's a lot of air down there---these guys had just tons! If I hadn't pulled the air out, I'm sure they woulda hurled.