Assessing Gastric Residual Volumes

Pediatric nasogastric tube placement

“…However, little data exist to support this practice. 13,14 There's a lack of standardization about GRV practices including frequency of GRV measurements, GRV thresholds, return or discard of GRV, EN termination, and/or reinitiation. Most of the published literature on this topic is focused on hospitalized adults, not pediatric patients.…”

Evidence-Based Practice Habits: Putting More Sacred Cows Out to Pasture

“…68,69 Most guidelines suggest the use of a large-volume syringe (60 mL) for aspiration of fluid because smaller syringes may collapse the gastric tube. 64,66 However, use of a syringe may not consistently result in aspiration of the total volume of fluid present in the stomach.…”

“…In fact, the evidence has demonstrated that checking a GRV in enterally fed patients does not improve patients' outcome or reduce complications. [65][66][67][68][69][70][71] So why do we continue to check GRV, and what evidence supports continuing this practice?…”

“…66 Similarly, if a gastric tube migrates near the gastroesophageal junction, GRV will be negligible in most cases. 69 Frequent monitoring (eg, every 4 hours) of GRV is indicated as one method to monitor gastric tube location. After obtaining radio graphic confirmation of accurate placement of a gastric tube, observing the appearance and changes in the volume of gastric aspirate may assist in monitoring for migration of the gastric tube.…”

“…Interventions to minimize aspiration include elevating the head of bed more than 30º, initiating continuous enteral feedings, using medications to promote gastric motility, and consideration of postpyloric feeding. [64][65][66]68,69 Ongoing evaluation of patients' tolerance of enteral feeding is also necessary to interpret GRV. Signs of intolerance may include bloating, abdominal pain, nausea, vomiting, and emesis.…”