How much gastric residual is too much?

[neuron]

Hi,

I recently had a patient with a PEG tube. The order said that if there was over 100ml of residual, then to wait and call MD, etc..Well, I was nervous pulling out the residual. We only have the 60ml syringe so I had to get a cup, put 60cc's in there, put the syringe back in the tube and retrieve more residual. Ok, it didn't come out to quite 100mls, but my question is is it safe to test residual that way (just let the gastric contents sit in the cup)? I was alone with no help (long story), so there was no choice to ask anyone, and I didn't want to wait to put back the residual because the patient needs it (potassium and electrolytes, right?). I'm still new.

How long can the residual stay out of the stomach before returning it back in within a safe time frame? Or I should say, how long have you waited until putting the contents back in?The issue is we have to be accurate, so hurrying isn't going to help if there is air in syringe while drawing it back up to put it back in the stomach. This takes time not to cram it back in as it should be done slowly?

Thank you.

[Sour Lemon]

I always do it the same way you did. I don't have an exact length of time in mind that it can stay out, but I can't think of any reason why it would be out for more than a few minutes.

100 residual is not a whole lot ...particularly if you have flushes programed into your feeding pump, but if that's your policy, then I guess that's your policy.

[neuron]

Thanks for responding. I guess what concerns me is it takes time to aspirate the residual and confirming the amount. Just wondering if someone knew of a time length so I don't get so nervous leaving it out because they are completely enterally dependent. Not pretty looking at this stuff. This particular case was bolus, not continuous.

If anyone has an article on how safe it is, please share.

[applewhitern, BSN, RN]

I don't put it in a cup; I usually have at least 2 of the 60cc syringes, so I don't have to put it in anything. I wouldn't think it would take you more than a minute or two to check residual and return the contents. Why would it be sitting out for longer than that? I also don't check residual after giving a water bolus or meds. The feeding doesn't go immediately thru the patient's system; it will be digesting in the stomach, just as food does, so you will usually have at least some residual. My rule of thumb is if they have 2 hour's worth of feeding as residual, then I hold the feeds, and re-check residual in about an hour. There really is no reason why you should have to return the contents all that slowly; just push it in. It is no different than if the patient drank it, it is going directly into the stomach. If they are nauseated, that is a different problem and shouldn't be given the feeding anyway.

[CharleeFoxtrot, BSN, RN]

I don't put it in a cup; I usually have at least 2 of the 60cc syringes, so I don't have to put it in anything. I wouldn't think it would take you more than a minute or two to check residual and return the contents. Why would it be sitting out for longer than that? I also don't check residual after giving a water bolus or meds. The feeding doesn't go immediately thru the patient's system; it will be digesting in the stomach, just as food does, so you will usually have at least some residual. My rule of thumb is if they have 2 hour's worth of feeding as residual, then I hold the feeds, and re-check residual in about an hour. There really is no reason why you should have to return the contents all that slowly; just push it in. It is no different than if the patient drank it, it is going directly into the stomach. If they are nauseated, that is a different problem and shouldn't be given the feeding anyway.

DING DING DING... that post was chock full 'o' win! Exactly so. If the order states 100ml residual, I always have 2- 60ml syringes handy.

[neuron]

I guess I'll be using two 60cc syringes now.