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A client admitted to the ICU due to unresponsiveness is diagnosed with cerebrovascular accident (CVA) and started on nasogastric tube feedings. Which of the following should be performed if gastric residual is more than 100ml?

Explanation

• Ensuring the patient is in a semi-Fowler's position enhances the gravitational flow of the solution, and prevents aspiration of fluid into the lungs.

• The entire gastric contents are removed and measured before every intermittent feeding (or every 4-6 hours for continuous feedings) to monitor for delayed gastric emptying. The amount is checked against the provider’s guideline or institution policy; unless the volume is great, it is reinstilled.

• If there is more than 100ml gastric residual, feeding should be withheld and the residual reassessed after an hour. Ideally, most or all of the measured residual fluid should be replaced into the patient’s stomach to prevent fluid, electrolyte, and nutrient loss.

• 4-6 hourly removal of the contents could disturb the client's electrolyte balance.

• The pH of the removed gastric content is tested first, before the gastric residual is removed, to confirm placement of the tube. The pH of gastric contents should be less than 5.5 and be green, tan, or white. If the patient takes an acid-inhibiting medication, less than 6.0 is normal. The fluid in the small intestines is yellowish or brown-green and thicker, and the pH is 6 or higher. If the pH is over 7, it indicates respiratory fluid, and an x-ray would be needed to check placement.

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