Re: Nutrition Support and Residuals

[Guest guest]

Carley

I looked in my ASPEN Nutrition Support Practice Manual and nothing specific

is addressed, perhaps others may have some.

However, I have to wonder the direction here. If the resident is eating a

pureed diet and that is the residual, wouldn't it be more realistic to

adjust the tube feeding? The ideal goal is to get adequate nutrition from

oral intake. What about changing to bolus only if he consumes less than 75%

of his meals? It does sound like he is getting overfed thus the residual of

the puree diet.

If it were me, I would prefer to focus on decreasing the tue feeding to

facilitate more oral intake.

Carol

>

>

> Our nursing department informed me that they held initiating a patients TF

> at 6pm (night feeds only 6p-6a) because " he had 200ml of residuals " . I had

> brought to their attention that the " residual " was his puree dinner and

> wouldnt it be common sense to not use this criteria to hold vs not hold a

> nutrition support feeding? " No, that is how we are taught " .

>

> Is there any evidence based information or ASPEN guidelines, etc that

> addresses residuals when po is also a contributing factor. The nurses and

> nursing instructor who happened to be present, are interested in clarifying

> this, as am I. TIA

>

> Carley Colotti RD, LD

>

>

>

--

" It is better to fail in originality than to succeed in imitation. "

Herman Melville

http://www.carolscasey.com

https://sites.google.com/site/carolscasey/

(w)

©

[Guest guest]

Thank you for looking!

Yes, the tube feed has since been adjusted and po is trying to be increased via

oral nutritional supplements and other HCHP food items. It is pretty standard

for our facility to run night feeds for 10-12 hours at night so they are off

early enought for Bfast at 715am and break after 5 pm dinner. The time overlap

between dinner and getting the tube feed up is close for some of these patients,

especially if someone is fed late or takes significant time to consume po.

I appreciate your help!

Carley

>

> >

> >

> > Our nursing department informed me that they held initiating a patients TF

> > at 6pm (night feeds only 6p-6a) because " he had 200ml of residuals " . I had

> > brought to their attention that the " residual " was his puree dinner and

> > wouldnt it be common sense to not use this criteria to hold vs not hold a

> > nutrition support feeding? " No, that is how we are taught " .

> >

> > Is there any evidence based information or ASPEN guidelines, etc that

> > addresses residuals when po is also a contributing factor. The nurses and

> > nursing instructor who happened to be present, are interested in clarifying

> > this, as am I. TIA

> >

> > Carley Colotti RD, LD

> >

> >

> >

>

>

>

> --

> " It is better to fail in originality than to succeed in imitation. "

> Herman Melville

>

> http://www.carolscasey.com

> https://sites.google.com/site/carolscasey/

> (w)

> ©

>

>

>

[Guest guest]

Thank you for looking!

Yes, the tube feed has since been adjusted and po is trying to be increased via

oral nutritional supplements and other HCHP food items. It is pretty standard

for our facility to run night feeds for 10-12 hours at night so they are off

early enought for Bfast at 715am and break after 5 pm dinner. The time overlap

between dinner and getting the tube feed up is close for some of these patients,

especially if someone is fed late or takes significant time to consume po.

I appreciate your help!

Carley

>

> >

> >

> > Our nursing department informed me that they held initiating a patients TF

> > at 6pm (night feeds only 6p-6a) because " he had 200ml of residuals " . I had

> > brought to their attention that the " residual " was his puree dinner and

> > wouldnt it be common sense to not use this criteria to hold vs not hold a

> > nutrition support feeding? " No, that is how we are taught " .

> >

> > Is there any evidence based information or ASPEN guidelines, etc that

> > addresses residuals when po is also a contributing factor. The nurses and

> > nursing instructor who happened to be present, are interested in clarifying

> > this, as am I. TIA

> >

> > Carley Colotti RD, LD

> >

> >

> >

>

>

>

> --

> " It is better to fail in originality than to succeed in imitation. "

> Herman Melville

>

> http://www.carolscasey.com

> https://sites.google.com/site/carolscasey/

> (w)

> ©

>

>

>

[Guest guest]

ADA has information in the Evidence Analysis Library. You could also

look for some of Steve McClave's work. He's a gastroenterologist and

past ASPEN president; he's done quite a bit of work in the area of

gastric residuals and enteral feeding.

One small snippet of information; if you look at " normal " gastric

capacity, we're probably talking in terms of 3-4 cup volume. Depending

on the composition of the residuals withdrawn, you could be looking at

normal gastric secretions, or perhaps residuals were drawn from a

" pool " . Hard to say for sure.

Typically, we don't recommend stopping enteral feedings for a

" residual " of 200 mL.

Regards,

pam

Pam Charney, PhD, RD

Pamela Charney and Associates, LLC

consultants in nutrition informatics

Transforming Nutrition Care With Informatics

pcharney@...

http://www.linkedin.com/in/pamcharney

" Those who say it can't be done are usually interrupted by those doing

it. " -- Baldwin

> Carley

>

> I looked in my ASPEN Nutrition Support Practice Manual and nothing

> specific

> is addressed, perhaps others may have some.

>

> However, I have to wonder the direction here. If the resident is

> eating a

> pureed diet and that is the residual, wouldn't it be more realistic to

> adjust the tube feeding? The ideal goal is to get adequate

> nutrition from

> oral intake. What about changing to bolus only if he consumes less

> than 75%

> of his meals? It does sound like he is getting overfed thus the

> residual of

> the puree diet.

>

> If it were me, I would prefer to focus on decreasing the tue feeding

> to

> facilitate more oral intake.

>

> Carol

>

> On Mon, May 9, 2011 at 3:25 PM, Carley

> wrote:

>

>>

>>

>> Our nursing department informed me that they held initiating a

>> patients TF

>> at 6pm (night feeds only 6p-6a) because " he had 200ml of

>> residuals " . I had

>> brought to their attention that the " residual " was his puree dinner

>> and

>> wouldnt it be common sense to not use this criteria to hold vs not

>> hold a

>> nutrition support feeding? " No, that is how we are taught " .

>>

>> Is there any evidence based information or ASPEN guidelines, etc that

>> addresses residuals when po is also a contributing factor. The

>> nurses and

>> nursing instructor who happened to be present, are interested in

>> clarifying

>> this, as am I. TIA

>>

>> Carley Colotti RD, LD

>>

>>

>>

>

>

>

> --

> " It is better to fail in originality than to succeed in imitation. "

> Herman Melville

>

> http://www.carolscasey.com

> https://sites.google.com/site/carolscasey/

> (w)

> ©

>

>

>

[Guest guest]

ADA has information in the Evidence Analysis Library. You could also

look for some of Steve McClave's work. He's a gastroenterologist and

past ASPEN president; he's done quite a bit of work in the area of

gastric residuals and enteral feeding.

One small snippet of information; if you look at " normal " gastric

capacity, we're probably talking in terms of 3-4 cup volume. Depending

on the composition of the residuals withdrawn, you could be looking at

normal gastric secretions, or perhaps residuals were drawn from a

" pool " . Hard to say for sure.

Typically, we don't recommend stopping enteral feedings for a

" residual " of 200 mL.

Regards,

pam

Pam Charney, PhD, RD

Pamela Charney and Associates, LLC

consultants in nutrition informatics

Transforming Nutrition Care With Informatics

pcharney@...

http://www.linkedin.com/in/pamcharney

" Those who say it can't be done are usually interrupted by those doing

it. " -- Baldwin

> Carley

>

> I looked in my ASPEN Nutrition Support Practice Manual and nothing

> specific

> is addressed, perhaps others may have some.

>

> However, I have to wonder the direction here. If the resident is

> eating a

> pureed diet and that is the residual, wouldn't it be more realistic to

> adjust the tube feeding? The ideal goal is to get adequate

> nutrition from

> oral intake. What about changing to bolus only if he consumes less

> than 75%

> of his meals? It does sound like he is getting overfed thus the

> residual of

> the puree diet.

>

> If it were me, I would prefer to focus on decreasing the tue feeding

> to

> facilitate more oral intake.

>

> Carol

>

> On Mon, May 9, 2011 at 3:25 PM, Carley

> wrote:

>

>>

>>

>> Our nursing department informed me that they held initiating a

>> patients TF

>> at 6pm (night feeds only 6p-6a) because " he had 200ml of

>> residuals " . I had

>> brought to their attention that the " residual " was his puree dinner

>> and

>> wouldnt it be common sense to not use this criteria to hold vs not

>> hold a

>> nutrition support feeding? " No, that is how we are taught " .

>>

>> Is there any evidence based information or ASPEN guidelines, etc that

>> addresses residuals when po is also a contributing factor. The

>> nurses and

>> nursing instructor who happened to be present, are interested in

>> clarifying

>> this, as am I. TIA

>>

>> Carley Colotti RD, LD

>>

>>

>>

>

>

>

> --

> " It is better to fail in originality than to succeed in imitation. "

> Herman Melville

>

> http://www.carolscasey.com

> https://sites.google.com/site/carolscasey/

> (w)

> ©

>

>

>

[Guest guest]

The ESPEN guidelines have recomendations for residuals. The new recomendation to

stop feeding is 500mL in 6h if I am not mistaken. Don't forget just from saliva+

esophagic secretions+ gastric juices is is around 3L per/day which gives

125mL/hour. 200mL is not that much.

Catia Borges

>

> Our nursing department informed me that they held initiating a patients TF at

6pm (night feeds only 6p-6a) because " he had 200ml of residuals " . I had brought

to their attention that the " residual " was his puree dinner and wouldnt it be

common sense to not use this criteria to hold vs not hold a nutrition support

feeding? " No, that is how we are taught " .

>

> Is there any evidence based information or ASPEN guidelines, etc that

addresses residuals when po is also a contributing factor. The nurses and

nursing instructor who happened to be present, are interested in clarifying

this, as am I. TIA

>

> Carley Colotti RD, LD

>