Duodenal small bowel feeding tubes are used to provide either short-term or long-term nutritional support in patients who cannot eat for various reasons. In some cases a patient with a feeding tube can eat but requires extra supplementation. Knowing how to check residuals is important to determine how well the patient is tolerating the tube feeding.
Know the goal rate. Before measuring residuals, it is important to know the target goal rate, which must be achieved gradually. This allows the caregiver to assess how well the tube feeding is being tolerated, based on the amount of residual.The goal rate is ordered by the physician in most cases and is stated in cc's per hour. For example, a goal rate might be 60 cc's per hour delivered on a feeding pump. Goal rates are only given for continuous tube feedings.
Bolus tube feedings, in which a predetermined amount of tube feed is administered manually, do not run on a pump and have no goal rate. Residuals should still be checked on bolus feedings to assess the patient's tolerance.
Don gloves. If the patient is on a feeding pump such as the Kangaroo pump, place the pump on hold. For patients not on a pump, ensure that the tube is clamped off in the middle with a clamp device provided by the tube's manufacturer.
Open the package containing the 60cc syringe. Remove the protective plastic cap on the end of the syringe. You should now be looking at the slip tip end of the syringe, which is used to draw up the residual.
Insert the tip of the syringe into the opening indicated for residual measurement. In certain brands of tubes, a double-lumen connector at the end of the tube has one port for attaching a feeding pump tube. A slide feature allows this lumen to be clamped off to avoid seeping, while a second port is opened for access. Be sure the tip is snugly inserted into the port to avoid leakage.
Gently pull back on the syringe to draw up contents of the feeding tube, while holding it securely in place. In some cases, only a very small amount, less than 5 cc, is aspirated. Be prepared for residuals as great as 200 cc or more by having styrofoam coffee cups handy. As the syringe fills up,empty its contents into a cup to save for replacement in the tube. Continue until no more tube feeding comes out; however, do not use excessive force.
Check that the feeding tube is either clamped off (if holding a feeding) or unclamped with the pump tubing securely attached. Restart feeding pump at desired rate. Remove gloves, wash hands, and record the residual amount and action taken.
Either return the residual to the patient, or discard it, depending on the amount obtained as well as the physician's orders. Although guidelines vary, residual in excess of 100 percent of the rate indicates that the feeding is not being tolerated. For example, in a patient with a rate of 50 cc per hour, if residual is 55 cc the tube feeding should be held. Returning residuals to the patient lessens the risk of electrolyte loss. Hold the tube feeding for one hour. Reassess the residual. If it is still around 55 cc, the healthcare provider should be notified before restarting. If the residual is say, 25 cc, the tube feeding may be restarted at half the goal rate. Check residuals at least every two hours. As the amount of residual decreases, the feeding rate can be gradually increased until it is back at goal rate.
Excessive residuals should be promptly reported to the healthcare provider. Follow institution policy and healthcare provider's orders regarding replacing residual, holding feedings, and resuming goal rate. Residual amounts and other information regarding patient's tolerance of feeding should be recorded in the patient's chart. Monitor residuals at least every four hours, or per institution policy.
- Medical-Surgical Nursing; Joyce M. Black, Esther Matassarin-Jacobs; 1997.
Roma Lightsey has written for "Grit," "Arthritis Today," and "The Clinical Advisor," a journal for nurse practitioners. Lightsey holds a Bachelor of Arts in communications, a Bachelor of Science in nursing, and a Masters of Science in nursing. She currently teaches nursing and works for a medical device company when not busy writing.