Gavage Feeding Policy Revision

nicunursejen · Jun 14, 2009

and when you have residual, do you put it back and subtract it from the feed, throw it away, or add it to the feed?

nicunursejen · Jun 14, 2009

and one more thing.... we use Bard infant feeding tubes made of plastic, and we change them every 72 hrs, does that sound reasonable?

texas2007, BSN, RN · Jun 14, 2009

1) That's how I measure

2) We use common sense...smaller ogt for smaller babies. No specific weight.

3) I do like 1 ml, if I don't hear it then pull that out and put in a little more. I usually go more by if I aspirate gastic contents though, since you can hear the air all over the belly in the tiny tiny ones.

4) We call if the residual is >25% of the last feed, or a funky color. What we do next depends on what the MD wants. Sometimes we chunk the residual and start with a fresh feed, sometimes we chunk the residual and make npo and get a kub, sometimes we give the kid more time to digest, sometimes we subtract that amount from the next feed, sometimes we keep feeding...sometimes the MDs will actually write an order to not check residuals (usually on kids that are recovering from NEC or what have you)....but I will still check it just for peace of mind. We do have a lot of NEC FWIW.

5)We use the orange anti-iv feeding tubes and are supposed to change them every 3 weeks.

NeoNurseTX, RN · Jun 14, 2009

1) That's how I measure
2) We use common sense...smaller ogt for smaller babies. No specific weight.
3) I do like 1 ml, if I don't hear it then pull that out and put in a little more. I usually go more by if I aspirate gastic contents though, since you can hear the air all over the belly in the tiny tiny ones.
4) We call if the residual is >25% of the last feed, or a funky color. What we do next depends on what the MD wants. Sometimes we chunk the residual and start with a fresh feed, sometimes we chunk the residual and make npo and get a kub, sometimes we give the kid more time to digest, sometimes we subtract that amount from the next feed, sometimes we keep feeding...sometimes the MDs will actually write an order to not check residuals (usually on kids that are recovering from NEC or what have you)....but I will still check it just for peace of mind. We do have a lot of NEC FWIW.
5)We use the orange anti-iv feeding tubes and are supposed to change them every 3 weeks.

I was about to say same at my place..but...no wonder, hah!

Although I can't find anything at work that says to call if it's >25% of the last feed. I've asked around for when to call for that and keep hearing there's no policy...which irks me.

nicunursejen · Jun 15, 2009

thank you for your input, so what if your residual is less than the 20 or 25%? Do you return residual and add the total feed or subtract the residual from the prescribed feed?

HappyBunnyNurse · Jun 15, 2009

Is it more accurate to listen for the air or to feel for it? We are taught to listen but I've noticed that a lot of people feel. I have tried feeling and noticed in really little ones I can actually feel it in the tummy whereas the sound may be all over the abdomen. I was also told that even if you hear (feel?) the air in the stomach it is not down far enough unless you get the air back. Opinions?

Mimi2RN, ASN, RN · Jun 16, 2009

The only truly accurate way of checking placement is an Xray. As those are not done on most babies, we go by aspiration, auscultation, and common sense. An OG at 16cm at the lip or nare, on a 18" baby, no residual, that feels "dead" when you aspirate is probably in the esophagus. I've been told "no resids all day", but a new OG and correct placement about 1cm below the zyphoid process will sometimes give back several ml's of partially digested milk. I think there is also a feel to correct placement, that sometimes comes with experience. Sometimes it's the common sense that's lacking..... Unfortunately, that can't be written into any policy.

NeoNurseTX, RN · Jun 16, 2009

Is it more accurate to listen for the air or to feel for it? We are taught to listen but I've noticed that a lot of people feel. I have tried feeling and noticed in really little ones I can actually feel it in the tummy whereas the sound may be all over the abdomen. I was also told that even if you hear (feel?) the air in the stomach it is not down far enough unless you get the air back. Opinions?

Confirmation on xray and remember where the cm mark is. If it's in the esophagus, you can still hear it in the stomach, esp on micros.

NeoNurseTX, RN · Jun 16, 2009

thank you for your input, so what if your residual is less than the 20 or 25%? Do you return residual and add the total feed or subtract the residual from the prescribed feed?

Return it and feed the next feed as prescribed...no subtracting.

dads40s · Jun 21, 2009

We just revised our policy in our NICU. We call if the residual is 50% of the last feeding or funky color or if abd changes (distention, visible loops of bowel, etc) MD or NNP decides if we pitch it, refeed it, stop feedings, etc. All other residuals are added to the next feeding and given over 30 minutes. Example would be if baby receiving 10 ml every 3 hours. 2 ml residual of partially digested moms milk. The 2 ml is added to the 10ml so that feeding would be 12 ml. All feedings are given with an infusion pump and given over 30 minutes. For ng/og placement we measure from the tip of the nose to ear to half way between xiphoid and umbilicus. Xray is the only positive verification, but we use aspiration of stomach contents, air auscultation. Experience has taught me that if I can not get the air back that I put in, it probably is not in the stomach.