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American Journal of Critical Care. 2008;17: 512-519
Copyright © 2008 by the American Association of Critical-Care Nurses.
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CE Article

Gastric Residual Volume and Aspiration in Critically Ill Patients Receiving Gastric Feedings

By Norma A. Metheny, RN, PhD, Lynn Schallom, RN, MSN, CCNS, CCRN, Dana A. Oliver, MPH and Ray E. Clouse, MD. Norma A. Metheny is a professor of nursing at Saint Louis University School of Nursing, St Louis, Missouri. Lynn Schallom is a clinical nurse specialist at Barnes-Jewish Hospital, St Louis, Missouri. Dana A. Oliver is a biostatistician at the Cancer Center of Saint Louis University Medical Center, St Louis, Missouri. The late Ray E. Clouse was a professor of medicine at Washington University School of Medicine, St Louis, Missouri.

Corresponding author: Norma A. Metheny, RN, PhD, Saint Louis University School of Nursing, 3525 Caroline Mall, St Louis, MO 63104-1099 (e-mail: methenna{at}slu.edu).

Background The helpfulness of bedside assessment of gastric residual volume in the prediction of aspiration has been questioned, as has the volume that signals increased risk of aspiration.

Objective To describe the association between gastric residual volumes and aspiration of gastric contents.

Methods In a prospective study of 206 critically ill patients receiving gastric tube feedings for 3 consecutive days, gastric residual volumes were measured with 60-mL syringes every 4 hours. Measured volumes were categorized into 3 overlapping groups: at least 150 mL, at least 200 mL, and at least 250 mL. Patients were categorized as frequent aspirators if 40% or more of their tracheal secretions were positive for pepsin and as infrequent aspirators if less than 40% of their secretions were positive for pepsin. Gastric residual volumes were compared between the 2 aspiration groups.

Results Approximately 39% of the 206 patients had 1 or more gastric residual volumes of at least 150 mL, 27% had 1 or more volumes of at least 200 mL, and 17% had 1 or more volumes of at least 250 mL. Large-bore tubes identified most of the high volumes. Eighty-nine patients were frequent aspirators. Volumes less than 150 mL were common in both aspiration groups. However, the frequent aspirators had a significantly greater frequency of 2 or more volumes of at least 200 mL and 1 or more volumes of at least 250 mL.

Conclusions No consistent relationship was found between aspiration and gastric residual volumes. Although aspiration occurs without high gastric residual volumes, it occurs significantly more often when volumes are high.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe the association between gastric residual volumes (GRVs) and aspiration of gastric contents.
  2. Recognize that measurement error is a significant problem in assessing GRVs.
  3. Understand that aspiration risk is significantly increased when GRVs are high.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


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Copyright © 2008 by the American Association of Critical-Care Nurses.