Residual Checks/Abd Girth

[ScammRNC]

Recently 2 members of our medical team went to a feeding conference and heard from a leading expert in NEC that his hospital does not check residuals or abdominal girths. So now we are looking into possibly changing our practice.

What is everyone else doing with residuals and girths? Presently we check residuals any time a portion of a feeding is gavaged. Based on where the residual falls into our residual protocol, 1. the full feeding will be given, 2. the residual will be refed and subtracted from volume to be given or 3. the doc will be called. Girths are checked at least every shift.

Any input is appreciated. Not sure how I feel about Not checking residuals.

[babyNP., APRN]

Girths are useless. Everyone measures them differently and they change day to day.

Residuals are a mixed bag. On my unit, we don't check them if they are trophic feeds (

[vanilla bean]

We assess residuals before each gavage feeding and girth twice per (12 hour) shift.

[rnkaytee]

We check residuals unless they're on trophic feeds - however, we are currently looking into changing as well and not checking at all, unless emesis/distention/etc. We've never checked girths routinely.

[essT]

Our policy is to check girths q8hr until the babies go to bolus feedings (at 1200-ish grams). Residuals are checked after every gavage feed and are reported to the team if it is over 50% of the previous feed. If less than 50%, we're supposed to refeed and proceed as usual. Of course anything suspicious gets reported, too.

[BittyBabyGrower, MSN, RN]

We measure once a shift. We teach everyone to measure right across the umbilicus. We check residual with hands on care. No check with priming feeds unless they look funky or have emesis.

A baby with a surgical belly is different, surgery dictates how often they want girths

even after they start feeds.

[NICUmiiki, DNP, NP]

We don't measure girth unless it's ordered, I haven't seen that yet. We measure residual with each bolus or Q4H with syringe changes for continuous feeds. We don't check residual if the feed is 0.5 mL/hr or less.

[karnicurnc, MSN, APRN, CNS]

We do not check abd girths as they are useless as stated previously.

Here are two articles that helped to provide evidence to change our practice from checking residuals to NOT checking them unless there are other signs of feeding intolerance (abd distention and emesis). Residuals alone are not a useful tool and actually lead to increased TPN days, increased central line days (and all inherent risks), increased LOS and costs.

Dilemmas Surrounding Interpretation of Gastric Residuals in the NICU Setting

The value of routine evaluation of gastric residuals in very low birth weight infants. - PubMed - NCBI

I am happy to email the articles directly to you if you are not able to access them.

[karnicurnc, MSN, APRN, CNS]

I wanted to share our newly developed feeding protocol related to gastric residuals. This is a section taken from our staff education presentation and explains the evidence behind our decision to no longer check residuals.

• Gastric residuals are a sign of poor gastric emptying and gastro-duodenal hypomotility or reflux common in the preterm infant and thus do not reflect pathology.
  
• Gastric residuals are influenced by feeding method (continuous vs. bolus), infant position, and feeding tube placement and size. Continuous feeds compared to bolus feeds increase the rate of gastric emptying. Position can influence gastric residual volume by as much as 25% . Prone or right lateral position following feeds decreases gastric residuals.
  
• Current evidence does not support that checking gastric residuals improves care or that gastric residuals are a predictor of NEC, sepsis, or feeding intolerance.
  
• Discarding gastric residuals may cause loss of essential gastric enzymes and/or acid and aspirating gastric residuals may damage or irritate the gastric mucosa.
  
• Although not statistically significant, in the study by Torrazza et al infants who did not receive evaluation of gastric residuals at every feed reached 150 ml per kg of enteral feeds six days sooner and required central venous access for six less days.
  
• Although infants who develop NEC have larger gastric residuals, a volume to guide practice has not been defined. In the study by Cobb there was an overlap between control infants and infants who developed NEC limiting the clinical utility of gastric residuals as a predictor of NEC.
  
• Bloody residuals were another marker in the study by Bertino et al but were not a risk factor by themselves.
  
• Gastric residuals in the absence of other clinical symptoms should not slow down enteral feeding advancement.
  

[ScammRNC]

Thanks, got the articles.