checking tube feeding residuals

[unsaint77]

1. After put the feeding pump on hold, how long do I wait before I use syringe to withdraw stomach content for residual? Or do I not have to wait?

2. If someone had NJ (the end of the tube is in the small intestine), do I still need to check for residual? If so, I should expect to see zero residual right? (whereas if it was NG, less than 100cc of residual is an expected norm).

thanks.

[sapphire18]

1. I dont wait to check for residuals- as far as I'm concerned you shouldn't, because even if it's just for a little bit the pt isn't getting the prescribed nutrition for the 24 hours between that and putting the TF on hold for other reasons like turning/lying flat and what have you.

2. There would be no residuals in the jejunum. Also, normal amounts of gastric residuals depend on the rate the TF are going at.

[sapphire18]

Question- you're a new grad, no? Just noticed and wondering why this is in the student section :)

[unsaint77]

Yes I am a new grad. There are people like you who like to help, and there are others who have nothing better to do than pounce on newbies with newbie questions. That's why I post it on student section.

So your facility do not make you check residual during the feeding? I thought checking residual was important to make sure the feeding is flowing well since the back up can cause serious aspiration.

So, if I was told to check for residual, I don't have to wait after holding the pump and before residual check?

thanks.

[sapphire18]

No no no I DO check for residuals- at least Q4 hours or per orders. I meant that I wouldn't wait after putting the pump on hold.Hope that helps:)

[Esme12, ASN, BSN, RN]

Yes I am a new grad. There are people like you who like to help, and there are others who have nothing better to do than pounce on newbies with newbie questions. That's why I post it on student section.

So your facility do not make you check residual during the feeding? I thought checking residual was important to make sure the feeding is flowing well since the back up can cause serious aspiration.

So, if I was told to check for residual, I don't have to wait after holding the pump and before residual check?

thanks.

I usually make students come to their own conclusion and tell me what they know first before I answer questions.

As a new grad my advice is slightly different. Working as a nurse you need to be guided by the facilities policies and procedures. If the policy says you are to check for residuals, you check for residuals. You have to follow the facilities polices when working or you can be fired for not following policies and procedures. Policies are developed to attain continuity of care and keep all employees at the same standard of care which prevents errors. Not following policy and something untoward occurs you can lose your job and your license. Not following policy can make you ineligible to be covered by your malpractice insurance for acting outside of policy and procedure or standard of care.

That being said....of course if the policy violates all standards of practice and threatens safety of course don't follow the policy as you are held responsible for your actions. this is what makes nursing so challenging.

Remember that before taking advice on the care of a patient any where online you should have researched the subject yourself and are just looking for others opinions as you never know exactly who is advising you. AN is a great source and I'll agree 99.9% of the time you will be just fine........but you just never know.

In short, remember the GI tract, esophagus, stomach, duodenum, jejunum, ileum and then colon.

J-Tube = Jejunem tube, placed in the jejunum, primarily for tube feedings. J-tube goes past the pyloric sphincter into the jejunum- small intestine via a hollow tube....... there is no little bucket to trap/pouch fluids. There should be no residuals.

Why the difference? Some patients are at higher risk for aspirations and J-tubes lessen that risk do to placement of tube feedings farther down the GE tract. In addition, sometimes they may want extended healing time or resting of the duodenum or stomach do to surgery, disease, etc. and opt for a J-tube.

To avoid a clogged feeding tube, thoroughly flush enteral feeding devices every 4 to 6 hours during continuous feedings and whenever feedings are on hold, before and after administration of feedings and medications, and after checking residuals.

Always use a large syringe (30 to 60 ml) for flushing to prevent rupturing the tube. Irrigate the tube with 20 to 30 ml of tepid water. No fluid has been found to be superior to water for maintaining patency.

The evidence I have found is that checking residual on J-tubes while is not harmful to the patient are not particularly helpful. It is more important to monitor abdominal distention and bowel sounds q 4 hours and to hold feedings for emesis, abd pain and distention.

American Gastroenterological Association

Also just because people don't agree with you it doesn't mean they are jumping on you. Nurses are strong willed opinionated individuals. We have to be to survive this profession. Nurses have a strict sense of right and wrong. What you might have been taught in school while not wrong.....is not the reality of how things must be done with real patients in the real world with real regulations. :hug:

People are going to disagree with you....... Just try to not be so sensitive. A large proportion mean you no harm when telling you different opinions and views on any given subject. :loveya: