EN tube feeding residual volume

[hungrysheep]

Hi! :)

Last week I got to take care of a GJ tube for the first time and I was able to administer medication through it with my instructor and nurses. However, I noticed that we don't really pull out residual volume before medication administration or intermittently throughout the day. I felt like I have been giving my patients lots of fluid with medications and pt's belly seemed little more distended when I went in for another medication. Bowel sounds were all there, active, but the drained urine amount remained the same (less than 50 ml drained with condom catheter).Condom catheter was found to be pulled off so that should be counted for less urine drainage too. Patient did have large BM 3hours before the first medication and the amount of urine drained at that time was more than 1 L :) (previous shift)

I was just little concerned that patient may not be emptying stomach properly so I asked my nurse if we have to pull out residual volume to check. The answer was kind of ambiguous and unclear to me, as they all told me to do so when physician orders to do it to assess patient's ability to empty the content. I eventually learned how to do it :) but i am little confused about the timing of it. I know I should have checked the policy more closely but did not get to look it up that day so I am planning to do it soon! The patient was stable and had no problem regarding feeding/ med administration throughout the shift and after. When I read the procedure guidelines it says to draw up residual volume to check every tiem before administering meds or starting a tube feed. I am little confused now. When exactly do we draw out residual volume to check? Would it be different depending on the hospital policies?

[nursej22, MSN, RN]

I am confused about what kind of enteral tube you were working with. EN and GJ are not abbreviations that I am familiar with.

Many enteral tubes do not give a return such as small bore feeding tubes such as Keo-feeds or Dobhoffs. Also so, if the tube is in the jejunum, there is no space as there is in the stomach for residual to collect.

Your patient had BT and a BM, so I would not be too concerned.

I would advise studying the different types of tubes and compare and contrast their uses and indications.

[Kuriin, BSN, RN]

Feeding tube - Wikipedia, the free encyclopedia

We tend to check residual on all feeding tubes with auscultation on NGT.

[Double-Helix, BSN, RN]

You won't get residual when feeding via the J port of a G-J tube. The feed is going directly into the small intestine and there is no reservoir from which to pull a residual. When feeding through the G port, checking residual can be done for several reasons. Most commonly, it's done when initiating or advancing feeds, or when their are concerns about bowel motility, to check how well the patient is tolerating the feeds. A patient chronically on G tube feeds without an acute GI concern may not require residual checks.

If you are concerned about a change in the patient's clinical presentation, you're within your scope to check a residual and report the results to the physician. Before you do, just make sure you're taking a few things into consideration: Is the patient on bolus or continuous feeds? How long has it been since the last feed? What would the expected residual be at this time? What other signs and symptoms prompted your concerns? This information will help you be prepared when you check the residual amount and communicate with the physician.

[AliNajaCat]

Look at the question of checking residuals this way. If you don't, and there's a lot of fluid in the stomach because there's a gastroparesis or blockage or ileus down below (although the BM yesterday is a good sign, maybe he won't be having another...mmm? ), what will happen when you put a bunch more in there? Or where will the meds go? Whose fault would that be then? Yours, that's whose.

The nurse has the discretion to check residuals ANY time it's warranted by suspicion of a problem, in addition to any prescribed interval in the medical plan of care. Indeed most of the time I've seen them, the physician doesn't specify that because it's a nursing responsibility to check to see if things are working before she puts more in there. Most facilities have a protocol for checking before bolus feeds and if X cc are found then the feed is held for 2 hours and try again, or checking qX hours for a continuous feed and holding it if the residual is > X cc, or something. Either way, though, if the stomach is overfilled and there's regurgitation and aspiration, saying, "I didn't know I could check it myself / it wasn't due to be checked for another four hours / or some fool thing like that" will land you in legal hot water.

The nurses you were with ought to have been able to give you better guidance; I wish I could tell you that every nurse you work with is going to know her business, or at least be able to discuss it with rationales for a student with a perfectly reasonable question. Hang in there and keep asking.