Before feeding a client via NGT, nurse checks for residual and obtains a residual amount of 90ml. What is appropriate action for nurse to take?

Correct Answer: D. Reinstill the amount and continue with administering the feeding.

If the residual feeding is less than 100ml, feeding is administered. Fasting volume of the normal stomach ranged from 0 to 98 mL in the study group. The researchers defined high as 100 mL for nasogastric (NG) tubes and 200 mL for gastrostomy (G) tubes and concluded that EN feedings should not be stopped for a single high GRV if there are no other physical examination or radiography findings to show actual gastrointestinal dysfunction.

• Option A: When interpreting Gastric Residual Volume (GRV), clinicians must keep in mind that the stomach has reservoir function and that the stomach fluid is a mixture of both the infused EN formula and normal gastric secretions. Chang and colleagues explained this concept in the article “Monitoring Bolus Nasogastric Tube Feeding by the Brix Value Determination and Residual Volume Measurement of Gastric Contents” published in the Journal of Parenteral and Enteral Nutrition (JPEN) in 2004.
• Option B: In a review article, “Measurement of Gastric Residual Volume: State of the Science,” published in 2000 in MEDSURG Nursing, Edwards and Metheny reported that the literature contained a variety of recommendations for what is considered a high GRV, ranging from 100 to 500 mL. Some sources have even (incorrectly) suggested holding tube feedings for a GRV of greater than 30 mL, or 1.5 times the flow rate, or even one-half of the hourly flow rate.
• Option C: Normal gastric emptying occurs within three hours and after a lag time of approximately one hour for a meal of solid foods. The process is slower for high-fat meals. Liquids empty more quickly (within one hour for a glucose solution and two hours for a protein solution).3 During fasting, the stomach secretes approximately 500 to 1,500 mL2; in the fed state, it secretes approximately 2,500 mL per day.