Question about checking residuals...

We check residuals on every little bean who has either an NG or an OG tube and is getting gavage feeds. We only check residuals BEFORE every feeding and never after because we want the baby to digest all that they can.

Once the baby is nippling, we let them nipple or breastfeed first and gavage the rest but we don't check residuals inbetween.

Then if the baby is nippling with no need for the tube anymore we pull it.

I'm confused as to why you have no scale in your unit.

I'm confused about that too! I have asked but so far no luck!

She shouldn't be checking infants after breast feeding because she is putting that breastmilk back FAST into the stomach and she is increasing the chances that the baby will spit up. Proper determination is to weigh the baby before and after the feeding or see if you can PO feed after breast feeding...if the baby is full he/she probably won't take anymore...if they nipple their full feeding, then they probably didn't get anything.

Our policy is NO SYRINGE/CUP feeding of NICU babies...period. Our lactation consultant fully supports it and a Neonatologist would probably rip a nurse's head off if they did it.

Our policy is as follows:

As long as a baby has an NGT or OGT, you check residuals as long as you are gavage feeding. If the baby has PO fed for 12 hours AND there hasn't been any issues with residuals for the last 24 hours, you can stop checking the residuals as long as the abdomen is nice and soft and the baby is stooling.

Once the baby has nippled all feedings for 24 hours (and of course, has been off all IV fluids), the NGT/OGT comes out.

None of this requires a physician's order. We also don't need a physician's order to put the feeding tube back in if the baby was PO feeding and then "craps out", but it's just understood among the staff that if you are only short a few mls, you give the baby a chance to make it up the next feeding before you put the tube back in.

Our policy is if there is less than one hour's worth of feeding in residuals, you administer the full feeding, be it gavage or nipple. So if you have a baby on 24 mls q 3, anything less than 8 mls would be acceptable.

You can place the baby for "tummy time" to help with digestion....it works wonders!

PS: I'm curious as to why you don't have a baby scale either considering a Neo cannot prescribe medications OR blood products without knowing the baby's weight.

All of our breast fed babies are weighed before and after nursing while wearing the same clothes, blanket and diaper that they were wearing before they start feeding. One of our pediatricians reminded us that as the breast milk enters the stomach some if it will go straight on into the small intestine pretty much right away and then it starts filling up the stomach so you can never know exactly how much a baby receives by checking aspirate after feeding. She said that weighing babies before and after nursing is more accurate for this and other reasons as well as being much more developmentally friendly. This nurse that checks to see how much is in their stomach after nursing is never going to be able to suck off all the baby ate, not to mention how bad it is to have to give back all that food with a syringe.. spit up city looming I'd expect. Seems like she has her heart in the right place but the science just isn't in her favor. Your unit needs a policy about weighing babies before and after nursing. If the feeding order say the baby should eat 50 ml every feeding and the baby gained 45 grams after breast feeding, then he/she should be given a bottle with 5 ml after nursing to make up the difference. Amazing how different all our units can be, and yet how similar they are in some other ways.

Our breastfeeding protocol is this: if a baby breastfeeds well for 10 min, they don't get supplemented after the feeding. If they br. feed for 5 min., they get half of the supplement, if they don't breastfeed at all, they get the full supplement. I have found the baby weigh scales to be inaccurate, and they usually make the moms feel bad when they show a weight loss after the feeding! And we only check residuals before feeds, not after