- 1). Know the goal rate. Before measuring residuals, it is important to know the target goal rate, which must be achieved gradually. This allows the caregiver to assess how well the tube feeding is being tolerated, based on the amount of residual.The goal rate is ordered by the physician in most cases and is stated in cc's per hour. For example, a goal rate might be 60 cc's per hour delivered on a feeding pump. Goal rates are only given for continuous tube feedings.
Bolus tube feedings, in which a predetermined amount of tube feed is administered manually, do not run on a pump and have no goal rate. Residuals should still be checked on bolus feedings to assess the patient's tolerance. - 2). Don gloves. If the patient is on a feeding pump such as the Kangaroo pump, place the pump on hold. For patients not on a pump, ensure that the tube is clamped off in the middle with a clamp device provided by the tube's manufacturer.
- 3). Open the package containing the 60cc syringe. Remove the protective plastic cap on the end of the syringe. You should now be looking at the slip tip end of the syringe, which is used to draw up the residual.
- 4). Insert the tip of the syringe into the opening indicated for residual measurement. In certain brands of tubes, a double-lumen connector at the end of the tube has one port for attaching a feeding pump tube. A slide feature allows this lumen to be clamped off to avoid seeping, while a second port is opened for access. Be sure the tip is snugly inserted into the port to avoid leakage.
- 5). Gently pull back on the syringe to draw up contents of the feeding tube, while holding it securely in place. In some cases, only a very small amount, less than 5 cc, is aspirated. Be prepared for residuals as great as 200 cc or more by having styrofoam coffee cups handy. As the syringe fills up,empty its contents into a cup to save for replacement in the tube. Continue until no more tube feeding comes out; however, do not use excessive force.
- 6). Check that the feeding tube is either clamped off (if holding a feeding) or unclamped with the pump tubing securely attached. Restart feeding pump at desired rate. Remove gloves, wash hands, and record the residual amount and action taken.
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