Policy Manual sample

MDT Home Health Care Agency, Inc. 52 GASTRIC RESIDUAL CHECKING PURPOSE: Gastric contents are measured to determine gastric motility, to prevent gastroesophageal reflux and potential aspiration for all patients on enteric feedings. Patients and caregivers are instructed to measure gastric residual contents before each feeding for those patients receiving intermittent feedings and once daily for those on continuous feedings. The physician will set parameters for holding tube feeding for residuals greater than 2-3 times hourly rate. Patients and caregivers are instructed to call the MDT Home Health Care Agency, Inc. nurse or physician if there are any questions regarding appropriate interventions with high gastric residual contents. RESPONSIBLE PERSONNEL: RN, LPN EQUIPMENT: Syringe (60 ml compatible with distal tube connection) Clamp, plug or stopcock.(as needed) Graduated emesis basis or container Non-sterile gloves GENERAL CONSIDERATIONS: 1. Routine measures of gastric residual volume are indicated when: • Initiating or upgrading volume, rate or concentration of enteric feeding solution • The patient is identified as high risk for aspiration • Emesis has occurred or is frequent event • The patient is febrile or is under other stress that alters metabolic function or state of responsiveness • The patient exhibits sudden restlessness, discomfort or respiratory distress during or after a feeding 2. Gastric contents are usually returned to the stomach because they contain nutrients, digestive enzymes and perhaps medications. If the contents exceed the ordered amount or if reflux is imminent, however, the contents may be discarded without serious threat of depletion of enzymes or electrolytes. This should be clarified with a physician order. Obvious loss of medication and discarded volume are reported to the physician. 3. Acceptable residual amounts may vary in physician orders. These are determined by consideration of the individual patient, recovery history ,risks , or tube placement protocols. 4. The sudden onset of slowed gastric emptying or reflux requires investigation to rule out: • Displacement or migration of the gastric tube into the esophageal or pyloric sphincter • Severe constipation or other form of intestinal obstruction • A patient position (e.g., flexed or left-sided) that delays emptying • Febrile or less conscious state