Evidence-Based Practice on Gastric Residual Volume Management for Patients with Enteral Feeding in the Community

Abstract Description

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Authors (including presenting author) :

LEUNG SS(1), LEUNG HY(1), LAW YL(1), YAU CY(1), LO YM(1), HEUNG LW(1), YIP TH(1), WONG YF(1), CHAN WMM(1)

Affiliation :

(1)Community Nursing Service, Princess Margaret Hospital

Introduction :

Enteral feeding has been widely accepted for maintaining nutrition in patients with impaired ingestion. Gastric residual volume (GRV) measurement has been used to evaluate feeding tolerance. Aspiration pneumonia is known as the most severe complication consequence of gastro-intestinal intolerance in patient with enteral feeding. However, guidelines of GRV management vary in the local clinical settings. Hence, an integrative literature review was performed to search the relevant evidence-based practice to inform the nursing practice in community.

Objectives :

(1) To review the evidence-based practice on GRV management (2) To standardize the nursing practice on GRV management in patient with enteral feeding in community settings

Methodology :

An integrative literature review was conducted regarding to GRV in three dimensions: (1) measurement method, (2) threshold of GRV and (3) refeed or discard the aspirated GRV. Cross nursing specialties discussion was initiated by Head Office Nursing Service Division and Evidence- based Practice Working Group to evaluate the practice gap and findings. Basic nursing standards and clinical guidelines on enteral tube feeding were reviewed and aligned according to the different findings. A training material of enteral tube feeding care was designed and disseminated to community nurses for knowledge enhancement.

Result & Outcome :

Evidences showed that GRV should be checked 4-8 hourly in continuously fed patients and before each intermittent feeding. GRV reading should be evaluated in conjunction with physical examination for abdominal distension, absence of bowel sounds, and presence of nausea and vomiting. Bedside evaluation and careful initiation of feeding might reduce aspiration risk. It was reasonable to use a relative proportion (50% of volume of feed) as the cut-off residual measurement. As there were wide range of feeding regimes from patients in community and used the absolute cut off volume which would not appropriate for them. There was no significant difference between refeed or not refeed gastric residuals (GR) to patients. Potential contamination of GR was main concern, therefore, no refeed GR to patients with enteral feeding was adopted in community settings. Despite different patient population and care settings across specialties with varying practices on GRV management, evidence-based practice findings provide valuable information to inform nursing practice in community and to improve quality of care for patients with enteral feeding.