Procedure for NG feeding/meds

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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!!

thank you! That's what I wanted to know...so those of you who said you would put it in a clean cup...one more question...you said you would return it...so how? Do you attach the syringe barrel and let it run in by gravity? Funny how student texts tell you to return the residual but there is no step by step instruction for that...

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Carol we return residuals because of the electrolytes and gastric enzymes found in residuals. Usually the residual is just undigested feeding. Yes I know it seems gross but I believe it's a necessity to keep F & E balance. And yes, always a sterile syringe even though it's a clean procedure. I mean, why not?

KXC yes that's exactly what we do in a NICU and you've heard "once a NICU nurse always a NICU nurse" and I guess that's why I want to get another syringe when I've filled the first one! I just couldn't see squirting residual into anything and then giving it back from whatever container I used.

Thanks for all your input!! Much appreciated!

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Specializes in Med Surge, Tele, Oncology, Wound Care.

Here is some research from the AACN Journal...

http://ccn.aacnjournals.org/content/29/5/72.full.pdf

I can tell you how we do it....blah blah, but this is evidence based....

We go by the limit being 200ml. I use a new emesis basin. I admit it is kind of gross...like flushing your vomit back into your stomach (well kind of). Better that then having acid base imbalance I guess.

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thank you rkitty! I appreciate your info! Yes I am looking for research-based procedures ideally!

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Specializes in Peds and PICU.

In our hospital, it is policy to check placement and a residual prior to each feed. If a patient is receiving continuous feeds, we check placement and residual every 4 hours. When I am pulled to NICU, I will use a new, clean syringe, auscultate air for placement, and then use the same syringe to aspirate gastric contents. The syringes we typically use in NICU are 5-10mL. If the residual is greater than the syringe volume, I will use another syringe, aspirate the remainder, and then leave the syringes in the isolette with the baby as I call the provider and get instructions as to whether to continue feeds, refeed residual, etc.

The NICU policy states that if the residual is greater than 20% of the total feed amount, you have to notify the provider (i.e., if the feed order is 10ml q3hrs, I would call the MD or NNP for a residual greater than 2ml).

I use the same procedure in PICU. However, the policy is a little different. If they are receiving continuous feeds and I check a residual every 4hrs, we report a residual greater than 1hrs worth of feeds. If they get bolus feeds, we still follow the 20% rule.

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Specializes in cardiology/oncology/MICU.
Here is some research from the AACN Journal...

http://ccn.aacnjournals.org/content/29/5/72.full.pdf

I can tell you how we do it....blah blah, but this is evidence based....

We go by the limit being 200ml. I use a new emesis basin. I admit it is kind of gross...like flushing your vomit back into your stomach (well kind of). Better that then having acid base imbalance I guess.

I had a professor tell me that we are checking the residual, but it belongs to the patient so give it back to them! Yuck:barf01:

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