NGT Gastric Residual Volume? What would you do?

[zlintones]

So... I have a nursing skills question that I need someone to answer for me because it's bugging me...

My friend had her skills test yesterday and she failed on one of her skills (but it wasn't the NGT portion of it) because the professor (who happens to also be our theory professor) was really picky and grilled into her with some crazy questions. The professor who did my skills test asked me a ton of questions too and I felt pretty confident, but some of the questions my friend was asked seemed really strange and since we've only had clinical experience in a SNF, I don't think it was really fair for this professor to grill into her like she did.

Anyway, my friend was tested on NGT medication administration, I know that prior to administering the med, I'm going to aspirate gastric contents and check GRV. I've learned that if GRV is more than 100mL, you will withhold giving the med and notify the MD because this indicates the stomach is not emptying like it's supposed to which can be r/t intestinal obstruction. However, this professor asked my friend, "What do you do if the GRV is 75mL and the med you are administering is 25mL? Do you give it?" My friend stated, "No, you withhold the med and notify the MD." The professor let her continue on, so I am assuming the question was answered correctly. BUT, I thought that if the GRV is less than 100mL, it was okay to give the med, even though you are giving 25mL, with a total of 100mL in the stomach once everything's said and done (well... actually, if you consider the flushing of the tube before and after, you would have something like 160mL). Does that matter that more than 100mL will be in the stomach? I don't have the clinical experience to know if that is right or wrong... But normal consumption of fluids in one sitting can be about 8-16 oz. (240-480mL) and if you add food in there, it's even higher... but you know, I'm thinking of a normal person who doesn't have a NGT, but it still doesn't make sense to me.

I was trying to think that out critically, but I'm stumped. What would you do and why? Every book I've read says clear as day, "If GRV is MORE than 100mL, you will withhold administering the medication, and notify the MD." This question tripped me up and I want to make sure that when I actually start doing this stuff in a real setting, I don't commit a med error or something of the sort.

[Esme12, ASN, BSN, RN]

Hummmm......100cc residual. I have always been told >200mls or 2 1/2 times the rate...100mls seems low. Many studies now indicate that checking for residuals before meds isn't necessary just ensure placement.

Anyone else?

[vera4130]

Our policy is 200 mL and good judgement. We also don't notify the doctor, just turn off TF for a few hours and check it again. If its resolved, turn TF back on, if not, then I would start thinking about notifying the doctor.

I've also held TF for residuals less than 200 when there are other things involved. One lady I had was in ARDS, and I stopped her TF at 150, because she wasn't processing it and had hypo active BS. The last thing she needed was to manage to aspirate too.

[nurseprnRN, BSN, RN]

I like the way the OP has tried to reason this out. Vera makes a good point too, which, OP, you will use when you have more experience. But for now, I think your professor is hanging on whether you can add 25cc + 75cc and come up c 100cc, and know that residual

[FineAgain]

GrnTea is right (as per usual) :)

In a clinical setting you would use critical thinking as well as protocol. In the school setting they just want you to know to hold at GRV >75. The 25 mL and flush are not residuals, therefore...you would not hold the med.