Checking residuals

  1. Quick question: how do you all check residuals for tube feedings? I was doing it q 4h, asked 3 different nurses and got three different answers. I got turn the pump off for 5, 30 and 60 minutes and also return the residual and throw the residual away. Silly question, I know, but would like some input. Thanks!
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    About ParrotHeadRN

    Joined: Nov '02; Posts: 153; Likes: 6
    Hospice Case Manager
    Specialty: 7 year(s) of experience in Med/Surg; Critical Care/ ED


  3. by   joyrochelle
    well i would guess that it would depend on how frequent u are doing the feedings, for when you cehck residuals, you know? like right before...and then perhaps an hour after? ( i work OB, so I am not altogether up to date on the practices, BUT i did just finish nursing school last srping, so I should know Something....)

    ANYWAY-- as far as i remember, you should record the residual amount, but never throw it away. You want it to go right back where it came from, if i rememebr correctly.
  4. by   NurseDennie
    In neuro, we had a lot of tube feeds. Remember, I've been away from BS care for a couple of years.

    But what we did was just turn off (pause) the pump and aspirate the stomach contents, and record the amount. You might have orders for some kind of rate, but mostly if the residual is the amount that's delivered in an hour or more, then you rinse well and turn the TF off for an hour. Recheck after the hour. If there's still too much TF see if you have an order for propulsid or reglan or something, or else call the doc. Some docs you just know well enough to know what he/she would want you to do.

    All residual is returned to the patient, because if you take it out and leave it out, you risk messing up electrolytes.


  5. by   NurseDennie
    P.S. Duhhh - You can't check residuals on the smaller-diameter lumens.

    What else was I going to say? I know I had two points I forgot to mention. Rinsing the tube?? No, I mentioned that....

    Oh, I remember, if it's a NG tube of any sort, you have to recheck placement before you re-start the TF.

    Thirdly.... I think I've mentioned most of it. I guess there is no third thing.

    Oh - I tell a lie! It's better to check residual after a turn! That was the third thing.


  6. by   ParrotHeadRN
    Thanks joy and Dennie. I was pretty sure of returning the feeding but then I had an older, much more experienced nurse tell me no, so I started doubting myself! Also, if residual is being checked q 4, would I still turn it off for an hour?
  7. by   nurseleigh
    I was taught (in school) that if the residual is twice the hourly rate or more than you do NOT return it to the patient, you throw it away. Anything under twice the hourly rate gets returned to the patient.

    I don't really know the parameters as far as turning the feeding off. I have done a few residuals and have never turned a feeding off first. All of the ones I did were 24 hour feedings, if that makes a difference
  8. by   renerian
    We taught check residuals q4, return the aspirated contents.

  9. by   Agnus
    Return the residual. If you don't you are upsetting electrolyte balance.

    The standard at our hospital is if residual is > 200% of the rate turn off feeding and recheck in 1 hr. contunuing to recheck until the residual is < 100%. Depending on the time it takes to lower residual you might need to adjust the feed rate, esepicially if after restarting you still have high residuals. .
  10. by   ParrotHeadRN
    Wow, you guys are a wealth of info. Thanks!
  11. by   Tweety
    Well, here is another answer. But return the residual, those are the patients digestive enzymes and electrolytes as have been pointed out.

    Our policy is q4h, we don't turn the feeding off for any length of time, we check the residual immediately after turning it off. If the residual is >100 cc we return only 100 cc and dump the rest, then follow a protocol based on the rate, if it is 1 1/2 times the rate we leave it off for an hour and check again. We'll notify the MD they are not tolerating the feeding if it is excessive, and perhaps they will order Reglan for motility or investigate further.