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Reinfusing gastric residuals

MICU   (3,190 Views 10 Comments)
by Rach4231 Rach4231 (New Member) New Member

438 Profile Views; 2 Posts

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Hi,

I'm new to my unit and haven't done this yet, but we have a protocol to check gastric residuals only if a patient exhibits intolerance to feeds. How do you actually reinfuse residuals? Manually or by pump? My preceptor isn't too kind when I ask these kinds of questions :)

Thanks!

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

6,171 Posts; 64,323 Profile Views

We only check residuals in tube feeds that aren't beyond the pyloric sphincter.

We use a syringe to remove the residual and it's placed into a graduated container and measured. Either the full amount or only the amount to be returned is then returned to the stomach via syringe, it is not returned as a slow infusion as there is no reason to do that, it was all just in the stomach a minute ago.

While that stomach juice looks nasty and I get why it feels weird to put it back, it's actually pretty important for maintaining normal GI functioning.

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2 Posts; 438 Profile Views

Thanks! Yeah, I questioned myself because it seems so gross! I understand why its important for pH and functioning though. Thanks again.

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ICUNurseG has 5 years experience and specializes in MICU.

75 Posts; 2,672 Profile Views

We check them on all gastric feeding tubes q4h. Anything 300ml and under is replaced. It can screw up ph and electrolytes if not. Think of it as if they vomited that much and how that would affect them.

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435 Posts; 7,746 Profile Views

We check q4 hours and reinfuse anything under 500 ml. Seems like a ton but really isn't. If it's greater than 500 then we usually stop feeds for a while and check to ensure they don't have other reasons for not digesting.

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100 Posts; 4,769 Profile Views

We also check with assessments, q 4h, and usually the orders are to reinfuse anything less than 500 mL. Reinfusing residual makes me want to vomit...but I know it's important for the patient.

I try to check the placement x-ray to see where in the stomach the tube is confirmed to be. Usually I will look at the image too. If the tip is fairly high, then I know that even if my patient's residual is 30-50 ml, actually they will have quite a lot in their stomach. Just something to keep in mind as part of the total picture.

When transferring patients to the floor, I usually have to tell the floor RN that we tolerate a high residual in ICU. Orders around that are typically changed by the hospitalists when patients go to the floor.

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KRVRN is a BSN, RN and specializes in NICU.

1,331 Posts; 11,676 Profile Views

Reinfusing residual is gross? In NICU we reinfuse STOOL! Often a baby that has perfed will come back with a stoma and mucus fistula. We collect the stool from the stoma bag and reinfuse it into the MF with a feeding tube and feeding pump to prime the distal gut for eventual reanastomosis. Nasty nasty nasty.

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vampiregirl has 10 years experience as a BSN, RN and specializes in Hospice.

1 Article; 651 Posts; 13,230 Profile Views

As you can see from the responses, everywhere has a different policy:) Where I worked (SNF) we reinstilled manually. I think our cut-off was 300 mL per policy but we also had several patients with specific physicians orders regarding residual - these patients had extremely complex medical issues (for a SNF!).

It's tough when you feel like your preceptor doesn't like to answer questions and you want to do things correctly. Maybe ask your preceptor to show you where to access the info for your unit so you can look it up yourself. Also, keep your eyes open for other nurses that are knowledgable and enjoy educating others. At some point you'll be on your own and will need resources.

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airborneinf82 has 8 years experience as a BSN and specializes in Trauma and Cardiovascular ICU.

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Just manually push it back in.

But as always, check your hospitals policy for numbers on when to hold, how much to re-infuse, etc.

Also, when you have the time, if you have a shared governance or whatever, look up and then pass along the latest research on tube feedings. Current studies show less than 500ml is no issue and even not checking residuals in intubated patients. There are obviously exceptions to these rules, but it is what current research shows.

Also, post pyloric and J-tubes you wouldn't check residual...

Ultimately though, it doesn't change your practice until a policy is changed, hence, check your policy. A lot of times hospitals will also have access to resources that cover nursing tasks and outline the steps to do things (aka Lippincotts [sp?], etc). Sometimes the policy will just say do "this" and you have to refer to the proper procedure there. Just FYI. Great things to address with your preceptor or other experienced RN there.

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NPOaftermidnight has 6 years experience and specializes in Surgery.

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Similar to what others have said - per our policy, we return up to 250mL and if the total residual is over 500 we hold tube feeds and notify MD. You return the residual manually with a toomey.

This is for NGT/OGT... residuals or not checked on post-pyloric feeds (NJT/Dobhoffs).

Your facility should have a clear policy on this (amount to refeed, amount to hold feeds, etc) and if they don't, I would bring this up to your manager (or a policy committee if something like this exists in your hospital). Also, this is a simple question and while we are more than happy to help, if you really feel that your preceptor would scoff at you for asking I would maybe see if you can be assigned a new one. It's important to your success that you are learning from someone that you feel comfortable asking questions to, no matter how silly/simple they might seem!

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