OK, so this isn't specific to the ICU, but I'll ask anyway.....
A couple weeks ago we received a communication in our mailbox that stated that the policy for checking residuals on tube feeds had changed. In a PEG tube, we re no longer supposed to check residuals. We are supposed to check residuals in NG-tubes, but only stop the tube feeding if residuals exceed 200 mL. I thought this was strange, and continue to check residuals out of habit.
So....the other night, I'm standing in the hallway preparing meds for my patient, and I hear in the next room a patient coughing repeatedly for about 30 seconds. I don't know what made me question it, it just seemed weak, rhythmic, and didn't seem to be producing anything. So, I knew the patient's nurse was in a nearby room, and I told her about it. We go into the room, the patient is profusely diaphoretic, and is on a tube feeding via PEG. We immediately stop the tube feeding, check the blood sugar, call rapid response, and start suctioning her orally and doing deep NT suctioning. We clearly get gastric contents from the lungs....she had aspirated. We pulled all the residuals from her stomach and get 300 mL!! The TF had been running at 55 mL/hr, so she had been backing up for at least 6 hours! Thank goodness I had to give meds to a nearby patient at that time (midnight). Apparently, she was fine 30 minutes prior to that during vitals, and the next set of vitals wouldn't have been for 4 hours! She was at the end of a hallway, and unless someone was making rounds, she probably wouldn't have been heard for a while.
Clearly, this is a case where checking residuals would have clued us in that there was a potential problem brewing. What is your hospital's policy? What would be the harm in checking residuals on everything? What evidence could there possibly be for giving a directive NOT to check residuals? We have raised this as an issue to the powers that be, but are awaiting a response. What do you think?
Specializes in Telemetry, Oncology, Progressive Care.
At my hospital we don't routinely check residuals unless a pt is symptomatic with their tube feeds. A high residual isn't really indicative of intolerance unless accompanied by symptoms. I have had pt's with high residuals and felt fine. Other pt's can have low residual and still be symptomatic with their tube feeds. We have quite a few patients on g-tube, g/j tube, etc and have been for some time. I have also had multiple discussions with the dietician and gi regarding this and their recommendation is to generally not check residuals.
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At my hospital we don't routinely check residuals unless a pt is symptomatic with their tube feeds. A high residual isn't really indicative of intolerance unless accompanied by symptoms. I have had pt's with high residuals and felt fine. Other pt's can have low residual and still be symptomatic with their tube feeds. We have quite a few patients on g-tube, g/j tube, etc and have been for some time. I have also had multiple discussions with the dietician and gi regarding this and their recommendation is to generally not check residuals.