Quick Guidelines for Managing G-Tubes and Gastric Residuals

How do you know when to check for gastric residuals? Although many of our kids do not have standing orders for gastric residual checks, clinical situations may arise that make checking the residual an essential process in gathering a clear understanding of what your patient is experiencing.
First things first: Use your judgment!
Have you observed changes in your patient’s feeding or GI status? Nausea or vomiting? Distension? If so, you will want to check the gastric residual to be sure that the patient is digesting appropriately. You will also know if large volumes of air and gas may be present.
How much is too much? General rule of thumb: If there is greater than HALF of the hourly formula volume remaining in the stomach, gently return the residual to the stomach, HOLD THE FEEDING for one hour, then check the residual again before resuming the feeding. If the volume continues to be greater than half the hourly feeding volume after one hour, continue to withhold any further feedings and CONTACT THE PHYSICIAN for direction.
Some kids have specific clinical conditions that make checking residuals ROUTINELY necessary!
Any child with a NASO GASTRIC TUBE must have residuals checked prior to any administration of meds or feedings. NG Tubes can slip more easily than G-Tubes since they are not secured by a stoma and a balloon. Check placement and residuals each time for these kids!
Kids with a history of poor feeding, gastric distension, nausea or vomiting have all the signs and symptoms that alert us to the need to be sure that they are digesting well. The process of assessing the stomach content volumes for these kids will help to clear any gaseous contents that the stomach may be holding as well as assessing feeding residuals.
Keep in mind the relationship between the risk for aspiration in patients receiving enteral nutrition!
Aspiration pneumonia is one of the leading causes of death in tube-fed patients.
Patients with high volumes of gastric residuals may be at an increased risk for aspiration.
The semi-Fowler position, where the child is reclined at approximately 30-45 degrees, is the optimal position for promoting digestion and reducing the likelihood of esophageal reflux.
Remember to check breath sounds and monitor respiratory status frequently.
Remember to document if residual checks are performed!
If a feeding is held, the entry on the flow sheet must reflect that action. The narrative note must detail the assessment of WHAT WAS SEEN, the intervention of WHAT WAS DONE (checking residual, and maybe holding the feeding), and the OUTCOME ASSESSMENT (how was the patient after the intervention?)