Procedure for NG feeding/meds

[PreemieNurse]

Hello...I would like your feedback on the way you deal with gastric residual at your facility. I am an educator and recently I overheard one of the other educators telling her students that when checking gastric residual from a feeding and the residual completely filled the syringe you were using, you may empty the syringe into the emesis basis, and reconnect the now-empty syringe to check for additional residual. This was shocking to me as I had never done this before and do not like the idea of having to "suck the residual back up" in order to return it to the patient. Yet I cannot find in any of the student's text as to the correct step when you have more than what the syringe holds...only what the maximum residual is for calling the doctor, shutting off the pump, etc. Can you tell me what you do in your facility? My feeling would be to get another syringe to continue, but another faculty member said she used to just use a clean glass to empty the syringe into. Not sure this is good practice either? I know it's not a sterile procedure, but I am thinking of the messiness of returning to stomach. Thanks in advance!!

[carolmaccas66, BSN, RN]

Doesn't sound good to me. I've never seen this done anywhere that I've done feeds. I WAS told once that the stomach is not sterile, when I went to use sterile WFI when flushing the PEG tube.

Why do you have to check for residual anyway? I haven't been taught that, can you explain further?

The whole procedure you describe sounds just GROSS to me.

[PreemieNurse]

Check for residual to assess for tolerance and digestion of tube feedings. Keep in mind that I am in a skills lab and we do not teach specific to any facility...we are merely teaching skills and we follow the descriptions found in their texts. Each facility will have their own policy. We stress to the students that they must follow the policy and procedure where they are doing their clinicals.

[PreemieNurse]

And like anything else in nursing practice, it must be backed up by the research...best practices!

[carolmaccas66, BSN, RN]

But do you flush the tube first before feeding? That way you wouldn't have to check for residuals or blockages.

[PreemieNurse]

Carol I don't understand the idea of flushing and not having to check for residual.. can you explain the correlation? The texts still advise to check for residual. This is in a procedure associated for giving NG meds (again, remember this is a skills lab)... the text gives them the information to check for residual before administering meds...

But my question is, what happens when your syringe is full of residual and you need to check for additional residual? Squirt it into a clean glass? Or just get another syringe (which I would do, but people don't agree with me, they think it's ok to use a clean glass).

Thanks!

[deemalt, BSN, RN]

You must check for residual. Why would you attempt to flush if the pt is not digesting their feeding? They could have an ileus or some other blockage.

We do tons of tube feedings at my facility. The syringes we use are 60cc. There are times when the residual fills the entire syringe and we have no idea how much more residual there may be. It does not seem realistic or safe to get another syringe. You would have to leave the room and either leave the full syringe at the bedside or carry it with you? We have disposable cups at bedside. Syringe gets emptied, more residual pulled out so you can get a true reading. All is returned.

[RNforLongTime]

When I check for residual, If I get a full 60cc, I go get a plastic cup and empty the syringe into that cup. Then I continue to check and keep emptying and rechecking until I get nothing but air returned. I've gotten up to 300cc residual in a pt on tube feeds before. I then return the aspirated contents to the patient and recheck residual later.

Not checking for residuals can lead to a pt aspirating tube feedings and getting an aspiration pneumonia! I've always been taught that you hold tube feedings for residuals of 150cc or greater. Then recheck in 1-4 hrs and again as per your facility's protocol.

[rachelgeorgina]

On my last clinical I was in the ICU. Tubes were aspirated for residual sixth hourly (patient's are on 24hrly continuous feeds. If there was more than 60mL of residual (i.e. the syringe capacity) it went into a fresh kidney dish (sterile/straight out of the packet, found in the ICU bedside cupboards so no leaving the bedside) so more residual could be aspirated. A max of 200mL was returned. Anything in excess of 200mL was disposed of.

[buenavidaRN]

I've always been taught, and practiced, returning all of the residual regardless of the amount. With that being said, if you are checking residuals regularly you shouldn't end up with an obscene amount.

When the residual is more than the syringe I use a clean cup and empty the syringe out. After obtaining an accurate measurement I return all of the residual back to the patient.

From what I have found, it isn't realistic to aspirate the residual (if more than 60 cc), put it back in the patient, go to the equipment/supply room, get a new syringe and do it all again. Nor, have I found this to be the practice at any facilities that I have been at.

Just my two cents ...

[carrotstix]

PreemieNurse, this has been my experience in NICU, probably drastically different from adults. If I have more aspirate than will fit in say the 10cc syringe Im using then I disconnect, put the full syringe to the side and use another until I have it all. When I call an advanced practitioner depends on how much the total volume of a feeding is and the color of the aspirate. If it's just a little partially digested formula I give it back, feed on top, and document. Sometimes if the residual is a nasty color we will toss it and feed fresh. Depends very much on the baby.

[carolmaccas66, BSN, RN]

OP, I think I was getting a bit confused re ur original post.

With anorexics with NG feeds, we used a 50ml syringe to aspirate the stomach contents to check the pH before commencing feedings. But I've never returned any residuals - I don't understand why you would do that - sounds pretty gross. I've been told by more experienced nurses than me that you don't even have to check the pH, because anorexics, or people at home with NG feeds don't do this at home.

Anyway, we used sterile syringes and injected the aspirated amount into a clean kidney dish. I was told by a CN that you don't really need sterile syringes for these procedures, as the stomach is not sterile. But I ALWAYS use a sterile syringe to flush anything, ie: NG feeds, PEG feeds.