G-J Tube Residual

[honeynurselpn]

So I have been working with my patient who has a G-J tube and I was told by her RN that before I start her enteral feeding I should check her gastric residual which makes perfect sense until she asks me to put in 30ml of h20 in there and only start the feed if I get the full 30ml back which makes no sense to me.

If I get all of it back doesn't it mean her stomach has more than 30 ml? I never get the full 30 because she eats hours before her feed at midnight.

When I check right after she eats I see the undigested food and over 30ml of residual.

Every article I have found online shows nothing about putting what she's talking about.

Is she right in the way she's doing?

[Sour Lemon]

That sounds bizarre, to me. I wonder if it was supposed to be a 30 ml flush before use and something got lost in translation?

[honeynurselpn]

No! She has shown me how she does it and even she doesn't get the full 30 back so she holds off the feed. She asks me very often if I "got back the 30". I'm glad I'm not the only confused one.

[Sour Lemon]

No! She has shown me how she does it and even she doesn't get the full 30 back so she holds off the feed. She asks me very often if I "got back the 30". I'm glad I'm not the only confused one.

It sounds like she got confused somewhere along the way and now she's confusing you (and me). I'm interested to see if anyone knows any legitimate reason this might be done???

[MunoRN, RN]

Just based on the positioning of the gastric port it wouldn't be surprising that you wouldn't get all 30ml back, aside from the lack of a rational basis for her assessment technique there is no such thing, she apparently has misunderstood some other premise of enteral feeding.

[LeChien, BSN, RN]

Read your facility/company policy & procedures. Also look at your orders.

[Neats, BSN]

I use Potter & Perry's Fundamentals of Nursing - it states this about GRV: return aspirated contents to stomach unless volume exceeds 250 mL (and then to check facility policy/orders) and not to administer feeding when a single GRV exceeds 500 mL or when 2 consecutive measurements (taken 1 hr. apart) each exceed 250 mL.

[neuron]

As for the 'G' and 'J' tube residual that you indicate in your title, I believe the residual would be different for the G tube rather than the J tube. The orders would be different for gastric residual which would be G-tube and the tube in the small intestine, J-tube.

[Liza50]

Before giving medications or tube feeding, I always checked placement and residual. If I got more than 60cc's, I put it back and came back in 1 hour. Always make sure the HOB is greater than 30 degrees.

[morte, LPN, LVN]

never check residual on J tube. and this RN has some wires crossed.

[Liza50]

Oops! Sorry only saw the G tube part. I never checked placement or residual on one of those. In fact, in my glorious student nurse aides days, actually pulled one out by mistake. There were three or four of us in there, I wasn't a nurse but I got blamed for it. They never told me to watch for it. First one I'd seen!