New guidelines for gastric residuals

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Specializes in Critical Care- Medical ICU.

Hi guys!

So on my unit, we have a new policy on gastric residuals stating that we will now only check Q8hr instead of Q4 and not to hold feeds unless residuals are >400cc (unless of course the pt is showing any signs of intolerance).

I know that this is evidence based practice and studies have shown no increased risk of aspiration or other complications with these higher residuals and that the pts benefit due to the increased caloric intake. The policy is also strongly recommending that gastric motility agents be considered and tried when residuals are in these higher ranges before just turning off feedings.

I definitely agree with the policy, I am just imagining how many 60cc syringes it would take to check residuals if they were that high! lol

Just wondering if anyone else has moved to this practice yet and if so, your opinion?

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Specializes in Emergency & Trauma/Adult ICU.

Yes, this sounds like our practice in the ICU in which I work.

It can be a tough sell to families of patients who have had g-tubes for a long period of time, and have gotten ingrained with the mindset of residual = trouble.

I can think of several patients who routinely get Reglan to increase motility.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I read someting somewhere about keeping the stomach fuller had improved nutrition and absorbtion mimmicking the digestive process of normal feeding/bolus feeding and there wasn't an increased risk of aspiration. Also with continous feeding/less intervention lead to less irritation and the gastric motility was improved. Of course I can't find the article now....What did your educator say the rationale was???

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Specializes in ICU.

Do you have those studies?

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Specializes in Critical Care- Medical ICU.

I have not personally seen or read any of the studies, but I plan to. The rationale I was given is that with this new policy we will be increasing nutritional intake without increasing risks to the patient. Hopeful that it will decrease ICU days in some cases. I've noticed that it is so easy in some cases for nutrition to be overlooked, especially in an ICU with so many other issues going on. We are all so weary of aspiration that feeds could be turned off for high residuals, and may not be started again for a couple days is some cases when maybe all we needed was a little reglan or maybe the patient was tolerating those residuals just fine anyway.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Do you have those studies?

NO Like I said I know I read them but I can't find them........I'm still looking....:lol2:

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