From the Research
Tube feeding should be stopped when the residual volume exceeds 250 mL, as this threshold is associated with delayed gastric emptying and increased risk of regurgitation and aspiration pneumonia, as indicated by a study published in 2016 1. When considering the management of tube feeding, it's essential to prioritize the patient's safety and nutritional needs. The decision to stop tube feeding is typically based on the residual volume, which is the amount of formula that remains in the stomach after feeding.
- A residual volume of more than 250 mL is generally considered high and may indicate delayed gastric emptying, which can increase the risk of regurgitation and aspiration pneumonia.
- If a single residual volume check reveals more than 250 mL, it's advisable to pause the feeding for 1-2 hours and then recheck, as suggested by a study published in 2009 2.
- For volumes exceeding 500 mL, feeding should be held, and the healthcare provider notified, as this may indicate a more severe feeding intolerance.
- Monitoring for other signs of feeding intolerance, such as abdominal distention, vomiting, or diarrhea, may be more valuable than routine residual volume checks, as research suggests that these checks may not significantly reduce aspiration risk and can lead to unnecessary feeding interruptions, as noted in a study published in 2015 3.
- For patients at high risk of aspiration, prokinetic agents like metoclopramide (10 mg IV/PO every 6 hours) may be considered to improve gastric emptying while continuing to provide necessary nutrition, as indicated by a study published in 1984 4. However, the effectiveness of metoclopramide may vary depending on the patient's condition, such as the presence of traumatic brain injury, as noted in a study published in 2009 2. In summary, the management of tube feeding requires careful consideration of the patient's residual volume, feeding intolerance, and overall nutritional needs, with a focus on prioritizing their safety and well-being.