I had a patient receiving continuous tube feeding with 100 cc of tube feeding residual. I referred to our tube feeding protocol and it stated to only hold tube feeding and notify MD if tube feeding residual is >250. Doesn't that seem like a lot of residual? I always thought that you were to hold and notify MD if the residual was greater than 20% over the hourly feeding rate. What do you all think? 0 Likes
november17, ASN, RN Specializes in Ortho, Case Management, blabla. Has 9 years experience. Feb 26, 2009 It's only a third of a cup. Doesn't seem like that much to me. The average stomach holds 4+ cups. 0 Likes
Creamsoda, ASN, RN Specializes in ICU. Feb 26, 2009 Yeah thats not that much. Our protocol is the same. If first residual is 250 or more, return up to 250 and continue feeds and start maxeran. Check in 4 hrs. If still high, refeed up to 250 ml and hold and have doc reassess. 0 Likes
EJSRN, BSN, RN Specializes in Med Surg, ICU, Tele. Has 2 years experience. Feb 26, 2009 I would follow policy unless the abd. is distended or pt is complaining. 100cc is not much. I've pulled residual that is much greater. I would check later and if residual is greater I would notify the doc because it sounds like an absorption issue. 0 Likes
gtmoore Specializes in Critical Care, Quality Imp, Education. Feb 27, 2009 Thanks for your input. 0 Likes
whipping girl in 07, RN Specializes in ICU, nutrition. Has 7 years experience. Feb 27, 2009 Try turning your patient to their right if you are getting high residuals, as this may help with gastric emptying. However, 100ml is not that much. The stomach can hold a lot more than that, although you should make sure the patient's head is up to at least 30 degrees, 40 is even better. 0 Likes
massrn116 Feb 27, 2009 I have been very leery to continue tube feeds on patients with "high" residuals. In my setting the patients are intubated and on sedation. We start at 10cc with goals around 50cc/hr. However, when I see bile in my low residuals I feel there is an absorption problem (which I report to the MD) Sure enough even with the low residuals I have had patients vomit. I do not think the physician takes into account the effect of the fentanyl and versed and is thinking that as long as the residuals are not 250cc the patient should be fine. 0 Likes
leslie :-D Feb 27, 2009 gawd, i HATE ngt's.i've seen too manyh folks aspirate...so i get nervous with residuals that normally wouldn't be a concern w/peg tubes.esp if pt is sedated.hate 'em.leslie 0 Likes
