How much residual is too much?

[txRN07]

We always have lots of feeding tubes on our unit, and it has been a long time since school, so I was wondering, when doing your residual checks, how many cc's would cause you to hold feedings? I've always gotten 5 or 10, and that's a given that you make continue, but the other night I had gotten back 30, which led me to wonder, what is the cut off amount?

[MayisontheWay]

It depends on the rate and how often you're checking residual. 2-3x the rate is generally what I've seen as the cut off, assuming you're checking Q4 hours. (Closer to 2x if it's a higher rate)

May

[elizabells, BSN, RN]

If they're not continuous, in the babies we use 1/4 of the feed as the cutoff.

[Christie RN2006]

Check the policy where you work. Where I work, if the pt has over 100ml TF residual, we hold the TF for one hour and recheck. If it remains over 100ml we leave it off and call the doctor. 100ml is not very much if you think about it... it is less than 1/3 of a can of pop, but if your TF is only running at 20ml/hr and you are having residuals of 50+ then something isn't right. Just be sure to check the policy where you work to see what it says.

[MikeyJ, RN]

On the ped's floor where I work, we typically hold the feeds if there is > 1/3 residual of the last feeding. However, we have no "protocol" as far as I know. We call the resident (or their private doctor -- although very few have privates) when there is 1/3 residual and ask if they want us to continue feeding or if they want us to hold the feeding. Our hospital requires an MD order to hold the feeding and then to begin the feeding again (kind of a pain in the butt) -- probably easier if we had a protocol.

Fortunately, we don't run into that problem often. I've only had to do it once within the last 6 months.

[suzanne4, RN]

First, it is going to depend on the age of your patients. And the type of patient population that you have.

There are no set rules in place, as feeding rates can vary greatly as well.

In adults that are getting 75 ml plus an hour, it is not uncommon to see residuals at times of 150 t0 200 mls. That would be little more than two hours worth of feeds and if checking every four hous, this is quite acceptable. But that patient would bear close watch and perhaps a more frequent check the next time.

There are so many variables that add in as well, hard to make a fast rule on it. But usually never more than two to three hours worth for residual.

Hospital or the facility should have a written protocol in place for what they want you to follow.

[Nursebarebari]

what does your facility policy says, mine is 200cc

[lori_alexis]

Im in an adult ICU. Our policy is if the residual is greater than 200 cc, hold it, then recheck. I can't remember if you hold for 30 min or an hr before rechecking. Then if they continue to be high contact metabolic support. I work nights, so the metabolic support comes by in the day and revises things. The last time I had to look at the policy my residual was almost 500, so I knew I was going to have to leave it off for several hours.

[jmgrn65, RN]

Our policy is 100ml hold for an hour and recheck. (adults)

So like others have said check your policy.