Aspiration and Evaluation of Gastric Residuals in the Neonatal Intensive Care Unit

Parker, Leslie A.; Torrazza, Roberto Murgas; Li, Yuefeng; Talaga, Elizabeth; Shuster, Jonathan J.; Neu, Josef

doi:10.1097/jpn.0000000000000080

Cited by 56 publications

(52 citation statements)

References 69 publications

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“…In neonatology, GRV measurement was once thought to be part of a prevention strategy for necrotizing enterocolitis.60 However, because checking gastric residuals is associated with a high percentage of held feeds and failure to meet enteral feeding goals without being a good marker of feeding intolerance, some neonatal clinicians no longer check residuals 61 . Holding feeds in response to GRVs can be a major reason why infants do not meet their feeding goals, 62 , 63 but the clinical value of GRVs for assessing feeding tolerance in this population is not established.…”

Section: Section 9 Complication Avoidance and Error Reportingmentioning

confidence: 99%

ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

328

531

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Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.

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Section: Section 9 Complication Avoidance and Error Reportingmentioning

confidence: 99%

ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

328

531

View full text Add to dashboard Cite

show abstract

“…Other studies involved neonatal intensive care (Hodges and Vincent, 1993) or adult intensive care nurses (Ahmad et al, 2012). The practice of routine GRV measurement is increasingly being questioned across critical care as a whole (in neonates, children and adults) (Parrish and McClave, 2008;Bollineni and Minocha, 2011;Kuppinger et al, 2013;Li et al, 2014;Parker et al, 2015). In a multicentre observational study in 19 adult ICUs in France, Quenot et al (2010) showed that, just by measuring GRV, the risk of delivering inadequate energy goals increased by 38%.…”

Section: Discussionmentioning

confidence: 99%

Paediatric intensive care nurses' decision‐making around gastric residual volume measurement

Tume

Latten

Kenworthy

2017

Nursing in Critical Care

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BackgroundMeasuring gastric residual volume (GRV) to guide enteral feeding is a common nursing practice in intensive care units, yet little evidence supports this practice. In addition, this practice has been shown to potentially contribute to inadequate energy delivery in intensive care, which remains a problem in critically ill children.. AimsWe aimed to explore paediatric intensive care nurses' decision-making surrounding this practice. MethodsA cross-sectional electronic survey in a single mixed general and cardiac surgical PICU in the UK. ResultsThe response rate was 59% (91/154) and responding nurses were experienced, with a mean PICU experience of 10.5 years (SD 8.09). The three main reasons for stopping or withholding enteral feeds were: the volume of gastric residual volume obtained (67%), the appearance of this gastric aspirate (40%) and the overall clinical condition of the child (23%). Most 2 nurses reported checking GRV primarily to determine 'feed tolerance' (97%) as well as confirming feeding tube position (94%). Nurses' perceived harms from high GRV were: the risk of pulmonary aspiration (44%), malabsorption of feeds (20%) and the risk of vomiting (19%). GRV was measured frequently in this PICU, with 58% measuring GRV before every feed, 27% measuring 4 hourly and 17% measuring 6 hourly.The majority of nurses (84%) stated they would be worried or very worried if they could not measure GRV routinely. ConclusionsPICU nurses' decision-making surrounding initiating and withholding enteral feeds, and determining 'feed tolerance' remains heavily based on GRV. PICU nurses' have significant fears around patient harm if they do not measure GRV routinely. Relevance to clinical practiceThis nursing practice is likely to be one of the factors that impair the delivery of enteral nutrition in critically ill children and as such its validity and usefulness needs to be challenged and studied in future research.

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“…Male (p=0.22), smokers (p=0.09), moderate life style pattern (p=0. 19) and those not receiving DVT prophylaxis (p=0.11) showed more GED episodes. Therefore it concluded that there were significant association of younger age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and body built with GED (gastric emptying delay) (p=0.000).…”

Section: Association Of Socio-demographic Variables With Ged:-mentioning

confidence: 95%

Effect of Reintroduction of Gastric Aspirate on Gastric Residual Volume Among Patients Receiving Nasogastric/Orogastric Feed Admitted in Icus.

Sharma¹,

Saini²,

Kalra³

et al. 2018

IJAR

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Enteral feeding (EF) is considered the preferred method of nutritional support for the critically ill and has reduced septic morbidity in high risk surgical patients, decreasing catabolic response to injury, maintaining bowel mucosal integrity, decreasing translocation of gut bacteria, improving wound healing and reducing septic complications. GI dysmotility implies feeding via a NGT is often associated with large gastric residual volumes, which may lead to increase in the potential for regurgitation and vomiting as used as delay in the achievement of nutritional goals and this can be managed by closely observing gastric residual volume (GRV). 5,6,7 GRV is the amount aspirated from stomach; it indicates that the GIT is functioning normally. 7 The practice of measuring GRV has become a routine part of enteral feeding protocols in the critical care setting, to assess the feeding tolerance, prevent gastric emptying delay and intolerance which may lead to increase in the potential for regurgitation, vomiting and a delay in the achievement of nutritional goals; however if the GRV is more than feed is often withheld unnecessarily. US guidelines state that GRVs of less than 500 ml should not result in termination of enteral feeding. 5,7 Disturbed GE occurs commonly in critically ill patients feed intolerance is an indirect marker of disturbed gastric motility and gastric emptying delay (GED). 2 Metheney et al. also conducted a study and concluded that no consistent relationship was found between aspiration and gastric residual volumes. Although aspiration occurs without high gastric residual volumes, it occurs significantly more often when volumes are high. 8 Juvé-Udina ME et al. showed that GED was almost 50% fewer if the aspirated contents are reintroduced than when the contents are discarded. 2 Some author concluded that High gastric residual volumes are not always indicative of gastric stasis, a low GRV does not protect against aspiration pneumonia. 5

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Aspiration and Evaluation of Gastric Residuals in the Neonatal Intensive Care Unit

Cited by 56 publications

References 69 publications

ASPEN Safe Practices for Enteral Nutrition Therapy

ASPEN Safe Practices for Enteral Nutrition Therapy

Paediatric intensive care nurses' decision‐making around gastric residual volume measurement

Effect of Reintroduction of Gastric Aspirate on Gastric Residual Volume Among Patients Receiving Nasogastric/Orogastric Feed Admitted in Icus.

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