G-tube bolus feeding question. Please help.

[RNmeee]

Dear nurses, I need to get some facts checked. For a person in bolus g-tube feeding, shouldn't there be a written physician's order/instruction for holding the feeding for certain amount of residual?

For the place I work, they only have instruction for how much bolus to administer @ what time. We just go off of nursing judgment in case we get lots of residual, which makes me little uncomfortable because with this particular pt. I do not know how much is too much residual, and what would be the best thing to do in case I get a lot of returns?

Not just that, granted that pt. is very stable. But who is to take guarantee that he/she will digest food properly at all times. Isn't that one of the reason to check residual in the first place?

Now I talked to the parents, that they feel fine not having any orders for holding feeding because thats what they have been doing for years.

I feel worried because I feel like with g-tube feedings, such orders are usually placed.

Or is there certain things I can do as nurse in case I get tons of residual?

Thank you in advance!!!

[ventmommy]

I don't think I have ever had a written order for when to delay/skip. If it's over 40mL, I return it and wait 30 minutes and check again. By then, it's usually fine. I know other parents who don't delay a feeding for anything less than 90mL return!

If this has worked for them for years, are they new to having nursing in the home? If not new, perhaps there is an order already in place to NOT check?

I agree that EVERYONE occasionally has an off day where digestion is slowed because they are exhausted or not feeling well.

[RNmeee]

Thank you for your response. I was worried thinking there would always be hold feeding order for certain amount of residual like in the acute care settings. I now understand why things are different with home care clients.

Still its a relief to hear it from another person who has been doing this for so long.

Thank you Ventmommy.

[caliotter3]

It is not difficult to get an order to cover whatever the parents have been doing successfully for years. That is sometimes how 485s get updated when something here or there falls through the cracks.

[tothepointeLVN, LVN]

I believe the rule of thumb is to hold if the residual is greater than the hourly rate.

[systoly]

Yes, you should have an order specifying when to hold feedings. Otherwise there would be no need to have an order to check residual. Now, in general, it is not necessary to have an order for checking residual, because it is normal to have a certain amount of residual, and digestion (gastric motility) doesn't maintain a constant pace.