Checking residuals

joyrochelle · Nov 30, 2002

well i would guess that it would depend on how frequent u are doing the feedings, for when you cehck residuals, you know? like right before...and then perhaps an hour after? ( i work OB, so I am not altogether up to date on the practices, BUT i did just finish nursing school last srping, so I should know Something....)

ANYWAY-- as far as i remember, you should record the residual amount, but never throw it away. You want it to go right back where it came from, if i rememebr correctly.

NurseDennie, BSN, RN · Nov 30, 2002

In neuro, we had a lot of tube feeds. Remember, I've been away from BS care for a couple of years.

But what we did was just turn off (pause) the pump and aspirate the stomach contents, and record the amount. You might have orders for some kind of rate, but mostly if the residual is the amount that's delivered in an hour or more, then you rinse well and turn the TF off for an hour. Recheck after the hour. If there's still too much TF see if you have an order for propulsid or reglan or something, or else call the doc. Some docs you just know well enough to know what he/she would want you to do.

All residual is returned to the patient, because if you take it out and leave it out, you risk messing up electrolytes.

Love

Dennie

NurseDennie, BSN, RN · Nov 30, 2002

P.S. Duhhh - You can't check residuals on the smaller-diameter lumens.

What else was I going to say? I know I had two points I forgot to mention. Rinsing the tube?? No, I mentioned that....

Oh, I remember, if it's a NG tube of any sort, you have to recheck placement before you re-start the TF.

Thirdly.... I think I've mentioned most of it. I guess there is no third thing.

Oh - I tell a lie! It's better to check residual after a turn! That was the third thing.

Love

Dennie

ParrotHeadRN · Nov 30, 2002

Thanks joy and Dennie. I was pretty sure of returning the feeding but then I had an older, much more experienced nurse tell me no, so I started doubting myself! Also, if residual is being checked q 4, would I still turn it off for an hour?

nurseleigh · Nov 30, 2002

I was taught (in school) that if the residual is twice the hourly rate or more than you do NOT return it to the patient, you throw it away. Anything under twice the hourly rate gets returned to the patient.

I don't really know the parameters as far as turning the feeding off. I have done a few residuals and have never turned a feeding off first. All of the ones I did were 24 hour feedings, if that makes a difference

renerian, BSN, RN · Nov 30, 2002

We taught check residuals q4, return the aspirated contents.

renerian

Agnus · Nov 30, 2002

Return the residual. If you don't you are upsetting electrolyte balance.

The standard at our hospital is if residual is > 200% of the rate turn off feeding and recheck in 1 hr. contunuing to recheck until the residual is

ParrotHeadRN · Nov 30, 2002

Wow, you guys are a wealth of info. Thanks!

Tweety, BSN, RN · Nov 30, 2002

Well, here is another answer. But return the residual, those are the patients digestive enzymes and electrolytes as have been pointed out.

Our policy is q4h, we don't turn the feeding off for any length of time, we check the residual immediately after turning it off. If the residual is >100 cc we return only 100 cc and dump the rest, then follow a protocol based on the rate, if it is 1 1/2 times the rate we leave it off for an hour and check again. We'll notify the MD they are not tolerating the feeding if it is excessive, and perhaps they will order Reglan for motility or investigate further.