Peg Tube Feeding

[lavidaesbella]

Has anyone ever had a patient with a peg tube feeding that had no residual during one shift and the next shift they had a lot of residual?

I had a patient with peg. I checked residual in the morning, lunch time, supper time, always before administering feed and medications. There were about 20 ml of residual in the beginning of shift and none after that for the remainder of the shift.

During the night she was having high residuals, so feeding was held. Next shift patient had large amounts of residual. I'm talking 2000 and higher. How can that happen?

[meanmaryjean, DNP, RN]

Bowel obstruction

[lavidaesbella]

I forgot to mention I only gave the patient maybe 1000 ml of feed and water in my shift but the next shift the patient had more than 2000 ml of residual. My question is why didnt I get any residual and the next day she had more than what was administered?

[seaofclouds21, BSN, RN]

I've seen patient's go from minimal residuals to high residuals, though not quite that drastically. It is possible to have more than what was administered due to the normal gastric secretions her body would be producing to digest the tube feeding, though not enough to make that big of a difference. How do you check residuals?

[NurseKatie08, MSN]

I've never seen that happen (at least not that high of residual with gastric feeds being held) so not sure specifically why. I would have asked for an order to hold feeds and to vent the g tube to foley bag to make sure everything was out!

[Woodenpug, BSN]

Not when I was the nurse getting zero residual. I had it happen when the nurse before me reported no residual. I discovered that she did not aspirate a small amount of air before attempting to get a residual. Something simple can account for strange findings.

[NICUmiiki, DNP, NP]

Did you push a little air down first (or at least before declaring no residual)? When I check residual in an NG/OG tube, sometime the end of the tube gets stuck to the stomach wall. If you keep trying to pull, it just sticks harder. If you push a little air, it pushes the tube away from the stomach wall and fluid is able to come up again.

[zoidberg, BSN, RN]

Assess your patient as well. Any abdominal distention? Bowel sounds? Complaints of nausea or fullness (or restlessness if unable to speak)?

Also, something to note: make sure you follow your facility policy regarding checking residuals (and whether you should check them or not) and what your parameters for notifying medical team are. Some evidence shows checking residuals leads to fewer patients meeting caloric needs without adding any significant reduction in adverse events. Monitoring patient for tolerance would include nausea, emesis, abdominal distention, restlessness, etc.

Effect of Not Monitoring Residual Gastric Volume on Risk of Ventilator-Associated Pneumonia in Adults Receiving Mechanical Ventilation and Early Enteral Feeding: A Randomized Controlled Trial. | Critical Care Medicine | JAMA | JAMA Network

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