G-Tube residual checks

Castiela · Sep 23, 2017

Our policy is to pause the feeds and check, if gastric motility is functional, you shouldn't get much in the was if residuals. Our policy is that anything under 250 mls is acceptable. However, generally if you are getting 150 ish mls, we will start with maxeran if not contraindicated.

Verifying tube placement can be a bit controversial. The only was to guarantee the tube is in the correct place is to verify via X-ray. I tend to verify by ensuring the external length is the same as when the X-ray was done. If it's out by 5 cms we will re X-ray. An air bolus will sound like a hyperechoic bowel sound the starts a second or two after you push the air in and end quickly after. It's harder to hear on very large patients.

I'm not a huge fan of the auscultation method of verification. I did an indepth lit review on is subject when I was an undergrad, and the literature essentially said correct identification rates were about 50%. (I apologize, this was a few years ago, so I don't have the sources without re researching them). I've had the tube in the lungs once when inserting it and the patient immediately went into a huge coughing fit so I removed the tube and the patient is fine. Unless the patient has no cough reflex, you'll generally know that the tube is in the lungs imho.

I've never used pH strips except in NICU grad patients. This is one are of nursing where there isn't a best way to continue to monitor the placement of the Ng. We just do our best and use our nursing judgement. I ask for an X-ray whenever I am uncertain as it's the only way to verify with 100% accuracy.

Hope this helps

bgxyrnf, MSN, RN · Sep 28, 2017

how do you check residuals if they're on continuous tube feeds? Or do you just pause the tube feeds, check immediately and then resume?

you just pause the tube feeds, check immediately and then resume.

Double-Helix, BSN, RN · Sep 28, 2017

I agree with the above posters- pause the feeding, check residual, return the aspirated contents, and restart the feed (if the residual is within normal limits). Assuming that you have a consistent rate of gastric emptying, your residual should be consistent also. If gastric emptying is too slow, the residual will be high, so you can get the information you need without interrupting the feeding.

Castiela gave a great summary of methods used to check tube position. The best answer is to follow the policy at your facility. It will vary from place to place. Our facility uses pH of gastric contents to confirm tube position. A x-ray is warranted if the pH is inconclusive or you have other reasons to suspect tube displacement.