Peg tube residual

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Specializes in Med Surg, ICU, Tele.

Hello All,

I had a pt. tonight with a peg tube and nutren pulmonary running continuously at 60cc/hr. When the residual was checked it was 300cc. I turned the kangaroo pump off and notified the MD. Now i was taught in school that you should always replace the residual that you pull out because the digestion process has already begun and your body has already broken the nutrients down and what not. The charge nurse said "absolutely not" you should always discard a residual that is that great. I talked to a few older nurses as well, and they agreed. I talked to a couple newer nurses and they also said that you should replace the residual. I dont know if this is a new thing or I just got it wrong in school, but it would make sense to me to replace it. The charge then called the doc and he told her it was fine to discard the residual. Which is fine because that is an order. If anyone has advice it would be helpful.

thanks.

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Specializes in LTC, assisted living, med-surg, psych.

If there's only a few ml's residual I'll put it back in, but 300 mls? Don't think so......if there's that much residual, something's not right and I'm going to hold the tube feeding until I troubleshoot the problem and/or let the physician know what's going on.

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Specializes in ICU.

Definatly if there is a lot of residual, like 300, I would throw it out because there is actually MORE in the stomach still, and you are not emptying it all the way out just by getting the residual out. There is more of a risk of aspiration than of any harm you will do to the stomach by pulling it out.

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Specializes in Making the Pt laugh..

I guess I am lucky because our feed regimes have orders written on them in regards to this, usually it tells us how much to replace and how much to discard. Everything over x amount is discarded while the initial is returned.

I saw my first aspiration this morning, a bubbling cough was heard from one of my Pt's room, I went in and saw undigested feed getting coughed straight out of the Pt's trachy. There was a reasonable amount of feed on her towel, (she has a drooling problem) talk about untidy. Her lung sounds were a bit soggy but apart from that she was ok, touch wood. It is interesting more so because she has had a PEG for about 8/12 and was sitting at 40 degrees. I guess I will find out more about what happened when I get to work tonight. Why does the "interesting" stuff always happen just before knock off so I can't follow the progress?

BTW my poo turned white and a chant of "oh poo, oh poo, oh poo" run through my head before I figured out what to do. Bad news this stuff happening at the end of a night shift when I am too tired to think and act clearly, Murphy's Law I guess.

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Specializes in Med/surg;correctional;nursing homes;OR.

G-tube residuals that are like 5cc, I would push it back in. but 300mls...No, I would discard it and let the stomach rest and Call the MD and let them know what's going on with the patient. That's like swallowing your own vomit. Yuck! :no:

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Specializes in Med/Surg.

I also have a question to add, how much residual is ok to have in a peg?

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Specializes in SNF.

I'm a "newer nurse" too. I was taught to put it back in as well. When you pull the residuals out, you're pulling digestive enzymes and flora out too, and that should go back into the patient. My med surge book (Smeltzer, 2008) also states "aspirated fluid should be readministered."

Teresa

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Specializes in Med Surg, ICU, Tele.
I'm a "newer nurse" too. I was taught to put it back in as well. When you pull the residuals out, you're pulling digestive enzymes and flora out too, and that should go back into the patient. My med surge book (Smeltzer, 2008) also states "aspirated fluid should be readministered."

Teresa

Exactly what I learned. But I guess it just boils down to "HOW MUCH".

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We were taught to give it back, no matter the amount, and recheck in 4 hours. If you don't give it back, what is the point in rechecking?

http://www.mc.vanderbilt.edu/surgery/trauma/Protocols/SCCGRV.pdf

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Specializes in ICU/Critical Care.

If I have a residual of greater than 4 times the rate at which the tube feeds are infusing, I shut the pump off for an hour and discard half of the residual. Thats what I was told at my last job. My book says to readminister it but if the patient has been vomiting, their abdominal girth has increased, I'm not putting it back.

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Specializes in ICU.
I also have a question to add, how much residual is ok to have in a peg?

I was always taught that over 2 1/2 times the hourly rate is too much. That's when you should shut it off. But some facilities are different and will have policies for it,, or if the patient has been having problems with residual, the doctor will specify it in his order.

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Specializes in ICU.
We were taught to give it back, no matter the amount, and recheck in 4 hours. If you don't give it back, what is the point in rechecking?

http://www.mc.vanderbilt.edu/surgery/trauma/Protocols/SCCGRV.pdf

The point in rechecking, even though you took it out, is to see if there is anymore gastric fluid build up in the stomach.

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