Gavage feedings

Originally posted by Karen Whiteted:

What is the practice out there regarding gavage feedings and residuals? Do you check every feeding and when do discard the residuals?

In my NICU, we check residual before every gavage feeding, and if the result is 20% or less than the last feeding, we refeed it and continue with the feeding. If the residual is over 20% of the last feeding amount, we report it to the doctor or NNP on-call for instructions. Barring other s/s of feeding intolerance, we're usually instructed to either discard it and continue with the feeding, or refeed the residual and subtract it from the next feeding amount.

We check our residuals every 4 hours, whether it is bolus(q1-2hus) or cont and before q3-4hrs. If it is over 50% (for bolus) or over 2 hours worth (for cont) we call the resident and we are advised to either pitch it or refeed and reassess in 2 hours. Our nutrtionist recommends always refeeding unless it is obviously really nasty (ie green or yellow) as you are discarding important electrolytes and enzymes.

We initiate gavage feeding if they are are preemies, have tachypnea or just unable to nipple. We check the girth, and the residual. It must be less than 20% of the total feeding. We normally return back in the ngtube. Depending on the amount we run it over 30-60min on a syringe pump. When it is finished I usually place them prone to help absorption better then when it is time I check residual again. Cycle feeding the same except it may run 4 on 2 hours off. You still check for residuals and potential bowel loops.

this question may sound so silly to others. is the term 'residual' also the same as 'gastric aspirates'? we have been using this NICU flow sheet in my new hospital and there is a space provided for both of these 'terms.' when should i use the term 'residual' or 'gastirc aspirates' when i refer to the output i have obtained from the NGT or OGT?

when i ask my colleagues what is the difference, nobody among them have an answer.

i ask this trivial question 'coz in my previous hospital we use the term 'gastric aspirates' when we refer to the output from NGT or OGT (whether it is undigested milk, or curdled milk, or with specks, or yellow to greenish color, or brownish color). am afraid i might misled my colleagues when i give report or hand-over if what i am referring to as gastric aspirate is different from what they think.

Residuals and gastric aspirate are the same thing.

thank you sparkyrn, that is what i believe too.

i just wionder why in our flow sheet, there were two spots where we have to record the gastric output (residual or gastric aspirate) when we mean the same thing.

aside from that portion in our flow sheet, one of the nurses i handed over with a few weeks back have asked me if i have a residual and gastric aspirates. it is good, perhaps, that there was no output when i aspirated the NGT that i have to say 'zero' or none, otherwise, i might have had a dialogue with her.

thanks again for your so precious and immediate responses to all of my questions.

If you have two spots, then one is most like for output from an NG/OG to gravity or suction, hence the term gastric output/aspirate.

For residual, it is what is left after a feed.

We have the same thing on our flowsheets and we use them as above.

"Residual" suggests that it is refed. Maybe "gastric aspirate" is meant to indicate output that is discarded and not refed? I agree though, they mean the same to me.

Our flowsheet also has both terms. The "residual" box is on the part of the sheet related to feedings - type of feed, PO/NG/GT, amount, etc. So if the baby is on feedings, this is where we document how much residual there was.

If the baby has an NG/Salem/Repogle in and is NPO, we will write NPO and what kind of suction (if any) is being used to vent the stomach, in the feeding portion of the sheet. On the back, where output is recorded, we have a box for "gastric aspirate" and that's where we'll document how much stuff is in the collection cup if the baby is on suction.

I agree that "Gastric Residuals" and "Gastric Aspirates" are basically the same thing in that they are both indicating that the contents of a stomach have been retrieved by aspirating the NG/OG tube with a syringe. If the baby is receiving feedings, I believe the term "Gastric Residuals" would be most appropriate since this is explaining how much "residual food" is left in the stomach at feeding time. "Gastric Aspirates" could mean the amount of "residual" food left in the stomach but coulc also mean any type of gastric contents aspirated with a syringe from the stomach. Babies who are NPO can often have gastric aspirates of things like cloudy mucus or yellow, green, bloody, brown or other colored aspirates depending on their health condition. Our flowsheets have "gastric residuals" as a top heading and under that we include the total amount of gastric residuals, the amount refed and the amount discarded. We often receive orders to "refeed _____ ml of clear/cloudy/or partially digested food". Whenever we get back something that is not normal (green, yellow, bloody, etc.) we report it and discard it and include it under the "Gastric Aspirates" area of our flowsheet. I certainly agree that the two terms are interchangable and the only difference would be how your hospital intends them to be used... how your physicians and nurse practitioners use the information to evaluate the babies progress.