NG Tube feeding, I am confused?

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I understand that before each feeding, you check that the tube is in the stomach by air bolus and pulling out stomach contents. In the lab, my instructor had us pull out ALL of the stomach contents, and then put it back in the patient's stomach. I didn't understand why you would need to pull all of it out? Wouldn't it be sufficient to pull some out, to make sure you're in the stomach? Why all of it?

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Because you are also checking to see how much residual is in the stomach and if you need to hold the feeding because of too much residual.

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Thank you so much.

I think I was getting confused because on the videos I've watched they just use air bolus and skip checking stomach contents all together.

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Specializes in LDRP, Wound Care, SANE, CLNC.

Yes, that is right, BUT. Checking residual can be misleading. 80% of the " residual" stomach contents is normal secretions and swallowed saliva, so even if the residual is 200 ml or more that does not mean it is of nutritional content. Removing all of the contents is not necessary, assessing the time and amount of last feeding and amount of " outs" is more accurate to assess if the client is ready for a feeding. Active sounds in all four quads is also an indication of good gut motility, which in turn would warrant a feeding if the time is right. You can not go by amount of residual alone for assessing if a client needs fed. So, there is no need to pull it all out.

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Specializes in Maternity.
yes, that is right, but. checking residual can be misleading. 80% of the " residual" stomach contents is normal secretions and swallowed saliva, so even if the residual is 200 ml or more that does not mean it is of nutritional content. removing all of the contents is not necessary, assessing the time and amount of last feeding and amount of " outs" is more accurate to assess if the client is ready for a feeding. active sounds in all four quads is also an indication of good gut motility, which in turn would warrant a feeding if the time is right. you can not go by amount of residual alone for assessing if a client needs fed. so, there is no need to pull it all out.

absolutely right! but for testing purposes it is necessary to check all residual and make sure that the amount doesn't exceed 200 ml.

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Specializes in Ortho, Neuro, Detox, Tele.

you can usually tell. after you do this a few times, there is a difference between the looks of stomach contents, and feeding residual. but you want to reinsert ALL contents to keep the stomach PH at normal limits.

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Specializes in I'd like to get into neonatal or ob-gyn.

is 200 mL limit a standard? I read a book that saying that the limit is 400ml? And does the limit vary from patient weight? Does anyone know what procedure to follow if the residual measurement exceeds the standard limit? Does the residual affect the amount of formula we put in or do we just follow whatever the amount of order says as long as it stays within parameters?

I'm a little confused with that part of the procedure.

sorry for the questions :) Thanks for your help!

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is 200 mL limit a standard? I read a book that saying that the limit is 400ml? And does the limit vary from patient weight? Does anyone know what procedure to follow if the residual measurement exceeds the standard limit? Does the residual affect the amount of formula we put in or do we just follow whatever the amount of order says as long as it stays within parameters?

I'm a little confused with that part of the procedure.

sorry for the questions :) Thanks for your help!

It seemed like all of my pts during my externship this summer were on feedings, so I'll share a little of what I learned...

There's no one hard-set standard for residuals, but most people will say 200 or 300ml. Many times, the order will state a specific amount. Ex: 150cc Isosource q6h, flush with 50cc water q4h, hold feeding if residual greater than 250cc".

Generally, you just hold the feeding for that time, wait till the next scheduled feeding, check residual again, and give if the residual is within the ordered limit. Some doctors will write to notify them if residual is greater than a certain amount, some won't. Some will write to notify them if the feeding is held more than X times, again, some won't. If you're unfamiliar with how things work on the floor you're on and you have to hold a feeding based on residual, just ask your instructor or another nurse for their opinion. I would generally call the doctor if the residuals were such that a feeding needed to be held twice in a row. I never saw an order where the amount of residual affected the amount of feed.

If when you're pulling your residual, it just looks odd, smells worse than normal, or you just feel that it's not quite normal, get someone to look at it with you. One of my pts was producing over 300cc of what looked and smelled like bile every 4 hours, you could tell it didn't look like normal stomach fluids, and you couldn't see anything that looked like left-over feeding in the fluid.

And, you generally don't pull anything out without putting it back as mentioned before...doing so would drop the pH of the stomach when you added the feeding.

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Specializes in I'd like to get into neonatal or ob-gyn.

Thank you for the insight! Very helpful. Tomorrow is my 2nd week of nursing school and we're doing NG insertions, residuals measurement -- all the good stuff for clinical skills lab and was curious :)

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