Gastric Residual Management for Bolus Tube Feeds
A gastric residual of 90cc does not require holding bolus tube feeds—continue feeding as scheduled. 1
Evidence-Based Threshold
The British Society of Gastroenterology (BSG) guidelines establish a clear cutoff: gastric residuals exceeding 200 mL warrant feeding policy review, not 90cc. 1 Your patient's residual of 90cc is less than half this threshold, indicating adequate gastric emptying and no need for intervention.
Why This Threshold Matters
Aspiration risk is not elevated at 90cc: The critical threshold for aspiration concern begins at residuals >200 mL when checked every 4 hours in patients with doubtful gastrointestinal motility. 1, 2
Routine monitoring protocol: In patients with questionable gastric motility, the stomach should be aspirated every 4 hours, and only when aspirates exceed 200 mL should feeding policy be reviewed. 1
Clinical practice patterns: While nursing surveys show 89% of nurses withhold feeds at volumes <300 mL, this practice contradicts evidence-based guidelines that support continued feeding at residuals well below 200 mL. 3
Aspiration Prevention Measures (Continue These)
Rather than holding feeds at 90cc, focus on proven aspiration prevention strategies:
Patient positioning: Keep the patient propped up at ≥30° during feeding and for 30 minutes afterward. 1, 4
Feeding method: Bolus feeding into the stomach is appropriate and permits higher feeding rates compared to jejunal feeding. 1
Avoid jejunal bolus: Never give bolus feeds directly into the jejunum, as this causes dumping syndrome—gastric bolus feeding is the correct approach. 1, 4
When to Actually Hold Feeds
Hold or reassess tube feeds only when:
- Residuals exceed 200 mL at 4-hour checks 1, 2
- Signs of aspiration develop (fever, respiratory symptoms, oxygen desaturation) 2, 5
- Abdominal distension or discomfort occurs 3, 6
Common Pitfall to Avoid
Do not use arbitrary low thresholds (like 100cc or 150cc) to hold feeds—this leads to inadequate nutrition delivery without improving safety. 3 The evidence-based threshold of 200 mL exists precisely to prevent unnecessary feed interruptions while maintaining safety.