Undigested -vs- Partially Digested Residuals

dawngloves, BSN, RN · Mar 17, 2006

I will recheck an undigested feed in a half hour. If it's still there,peds usually tells me to refeed and hold the new one. If later that kid still has the feed in

the belly, we'll most likely toss it and the kid bought himself a NEC workup.

Digested feeds we'll feed through.

Not to highjack, but what percentage of a previous feeeds residual will you call peds for? We call if it's more than 50%. (this is barring an ugly looking residual)

Love_2_Learn · Mar 17, 2006

Thank you for your answer DawnGloves. When you said that finding undigested residual 30 minutes after refeeding it will buy the baby a NEC workup, this reinforces my feeling that undigested residual could be an early ominous sign. I just have an uneasy gut (lol) feeling about finding undigested residuals...

To answer your hijack, we generally have a "refeed amount" order for each baby. Our doctors and nurse practitioners generally say to refeed up to 30% of the total feeding amount ordered, sometimes just 20%. They never order "Refeed 30% of total feeding amount" but will order the actual amount like "Refeed up to 6 ml". Each baby has a "refeed" order which is generally written when they start NG/OG feedings and is usually not updated until a problem occurs... like a baby I had last night receiving 38 ml q3h and still having a 3 ml refeed order. (Big sigh).

Thanks again for answering my post. I really appreciate it.

dawngloves, BSN, RN · Mar 17, 2006

It could be an early sign of NEC or intolerance, but sometimes it is the babies position or they just need that extra few minutes, especially if there is a formula change. There has been many a time that I've checked a residual that was undigested and 20 minutes later it was all gone.Or I've had a baby on there stomach the next feed and it mad all the difference. Most of the time these NEC work ups find nothing.

Love_2_Learn · Mar 17, 2006

Thanks DawnGloves, knowing your NEC workups often don't find anything and also that the fresh-looking residual goes through the stomach sometimes just as the partially digested residual does makes me feel better too. Refeeding undigested appearing food is something I've not done much of in the past. I like to keep babies prone as much as possible to help with digestion; it really does seem to help in my experience.

Thanks again for your comments. After speaking with you today I am sure I will be able to sleep a little better this afternoon before going back to work tonight. Honestly, your comments have helped me quite a bit with my little conflict!!!

:icon_hug:

Gompers, BSN, RN · Mar 18, 2006

I will recheck an undigested feed in a half hour. If it's still there,peds usually tells me to refeed and hold the new one. If later that kid still has the feed in
the belly, we'll most likely toss it and the kid bought himself a NEC workup.
Digested feeds we'll feed through.
Not to highjack, but what percentage of a previous feeeds residual will you call peds for? We call if it's more than 50%. (this is barring an ugly looking residual)

Same deal here, for everything you wrote. Though for the amount, we will call if it's >1 hours' worth, so the % is different depending on how often they're feeding (Q2-3-4H).

Gompers, BSN, RN · Mar 18, 2006

It could be an early sign of NEC or intolerance, but sometimes it is the babies position or they just need that extra few minutes, especially if there is a formula change. There has been many a time that I've checked a residual that was undigested and 20 minutes later it was all gone.Or I've had a baby on there stomach the next feed and it mad all the difference. Most of the time these NEC work ups find nothing.

Yep yep yep. If I find a large residual, undigested or not, and the baby isn't on his/her tummy, I flip them onto it and check again in 30 minutes. Usually does the trick. Wonder why???

dawngloves, BSN, RN · Mar 18, 2006

Same deal here, for everything you wrote. Though for the amount, we will call if it's >1 hours' worth, so the % is different depending on how often they're feeding (Q2-3-4H).

We have an attending that doesn't want to hear about less than a two hour residual on a continuous feed. The baby has the one hours worth going in and will have another hours worth there already. :uhoh21: It makes sense when he tells it.

Gompers, BSN, RN · Mar 18, 2006

We have an attending that doesn't want to hear about less than a two hour residual on a continuous feed. The baby has the one hours worth going in and will have another hours worth there already. :uhoh21: It makes sense when he tells it.

They actually tell us not to check residuals with continuous feeds. It makes snese when they say it, too - usually the baby is on continous feeds becuase of an intolerance to bolus feeds. So by drawing back a residual and then pushing it back in, it's like bolusing the baby and increases their chances of emesis. Plus, we'd always have residuals with continuous feeds since the stomach is never empty. So we go more by the baby's clinical exam and assessment to determine feeding tolerance in babies on continuous.

So confusing sometimes!!!

Finallyat40 · Mar 18, 2006

and any change to baseline data (i.e., A&B's, increased girth, temp, fussy baby, visible bowel loops, etc). We always notify the provider if the residual is more than 20% of the previous feed, and whether they refeed, discard and continue or make NPO and get a workup is dependent on all the above and a KUB. Many times, all it takes is a simple change in position to help work it through....one of our docs has been pushing putting them on their left sides for one hour after feeds....apparently read a study. I haven't seen any difference there, but if I've got a kid with a residual, I'll definitely put them on their tummy and wait 30 minutes...usually makes all the difference in the world.

Also for these little guys who are getting trophic feeds (I had one ordered last week for 1.3cc q 3h:lol2: , sometimes they'll have residuals over and over, and the "cure" is simply to increased the feeds a bit...there's not enough going in to stimulate the system.

Jamie

dawngloves, BSN, RN · Mar 18, 2006

Also for these little guys who are getting trophic feeds (I had one ordered last week for 1.3cc q 3h:lol2: , sometimes they'll have residuals over and over, and the "cure" is simply to increased the feeds a bit...there's not enough going in to stimulate the system.
Jamie

Oh yeah. You definatly have to fill the gut to promote digestion. More craziness. It's an art , not a science. :lol2:

NicuNightRN · Mar 18, 2006

Yeah, putting the baby prone seems to usually do the trick! If the feed is still there after 20-30 minutes, or looks ugly, I'll notify the doc or NNP. We call for a residual > or = to 50% of the previous feed. But, if a baby is on full feeds and has not been having residuals or more than a few mL's, I would notify for a residual of say 10 mL that isn't digested by putting the infant on his or her tummy.

And I don't want to hijack the thread either...but going along the same lines as residuals. How often do you check them? I only check as often as I feed. So if the baby is only getting fed Q6, I check residuals Q6. Last week, I got report from a nurse who was checking residuals every 3-4 hours on a baby being fed Q6, and notifying the doctor of these residuals even though the baby wasn't due to eat for another 2-3 hours. Any thoughts?