Nursing practice of checking gastric residual volumes based on old dogmas: opportunity to improve patient care while decreasing health care costs

Abstract

It is a common practice to check gastric residual volumes (GRV) in tube-fed patients in order to reduce the risk of aspiration pneumonia. However, there is a paucity of scientific evidence to support this practice which consumes significant amounts of health care resources. We conducted a survey of the nursing practice of GRV checks in our hospital as part of a systems improvement project using a standardized questionnaire in a single hospital setting. The questionnaire included questions about the practice of checking GRV including what constituted "high" GRV and adherence to physician orders. We observed a wide variation in the responses of the practice of management of GRV. All the nurses in our hospital checked GRV, whether or not there were physician orders. Nurses' responses to "high GRV" varied from 100 mL to 200 mL at which point they would withold feedings. Some, but not all nurses, would report the "high GRV" and witholding of feedings to the physicians. The wide variation of gastric residual checks, including unnecessary checks and withholding feedings, observed above not only increased health care costs but also has the potential to impact patient outcomes. This calls for a standardized evidence based tube-feeding protocol to check GRV and should be an integral part of hospital policy. For the benefit of the readers, we present the GRV check protocol instituted in our hospital which, based on anecdotal reports, is resulting in decreased interruptions of feedings to our patients and reducing the nursing time consumed, thus potentially decreasing health care costs.