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Research for Practice
This literature review substantiates that there is confusion regarding what constitutes excessive gastric residual volume in adult tube-fed patients. Only one research study regarding gastric residuals was located; it indicated that 200 ml for a nasogastric tube and 100 ml for a gastrostomy tube should cause concern. The implications of these findings for adult-health nurses are discussed.
A major nursing responsibility to prevent aspiration in tube-fed patients is assessing for the rate of gastric emptying. This is accomplished by measuring the amount of gastric contents at regular intervals during continuous tube feedings or prior to each intermittent feeding. It is commonly accepted that high gastric residual volumes increase the risk for pulmonary aspiration (the most severe complication of tube feedings). An excessive accumulation of enteral feeding and gastric secretions causes distention and greatly increases the potential for regurgitation and vomiting with subsequent aspiration of the gastric contents into the lung. Risk factors most commonly associated with aspiration in tube-fed patients are listed in Table 1. However, several problems surround this seemingly simple nursing assessment. First, the recommendations for frequency of gastric residual volume (RV checks vary greatly (see Table 2). Second, there is little agreement as to what constitutes excessive gastric residual volumes. The purpose of this article is to review research studies and current opinion on gastric residual volume and discuss the implications for medical-surgical nurses.
To Measure or Not?
In general, the measurement of gastric residuals is somewhat controversial. In fact, some authors believe that gastric residual volumes should not be measured at all because this maneuver can cause tube clogging (Powell, Marcuard, Farrior, & Gallagher, 1993). However, it is important to note that this is not a problem if the tube is properly flushed with water after checking the residual volume (Hudak, Gallo, & Morton, 1997; Parsa & Shoemaker, 1995; Rombeau, 1996; Viall, 1993). The risk for potential aspiration from a massively distended stomach is much greater than is the risk of a clogged improperly handled tube. Some clinicians contend that gastric residual volumes should not be monitored because it is usually impossible to withdraw fluid from small-bore feeding tubes. To the contrary, numerous clinical studies have documented that fluid can usually be withdrawn from small-bore tubes...