Mauricio Rosas-Alvarez, DI October 23, 2013

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Holding Tube Feeds for Residuals:
How Much is Too Much?
Feb 1997 a study from Cedars-Sinai
Medical Center shows that at commonly
encountered rates of formula delivery
and gastric emptying, the gastric
residual volume would plateau at a
volume well within that found in the post
prandial stomach.
Nov 2008 Am J Crit Care publishes
study stating no consistent relationship
between aspiration and GRVs.
Aug 2012 South Med J survey study
concluded the decision to withhold NGT
feeding varied significantly among the
nursing staff
A.S.P.E.N.-
500mL or greater
Cleveland Clinic-
400mL or greater
ADA Guidelines (c. 2008)-
250mL or greater
American Gastroenterology
Association (c. 1995)-
200mL or greater
It all depends on your care team consensus
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.
-Todays Dietitian June 2010
Reignier J, Mercier E, Le Gouge A, et al. Effect of not monitoring residual gastric
volume on risk of ventilator-associated pneumonia in adults receiving mechanical
ventilation and early enteral feeding: a randomized controlled trial. JAMA.
2013;309(3):249-56
In terms of protection against Ventilator Assocated Pneumonia (VAP), a
protocol of enteral nutrition management without Gastric Residual Volume
(GRV) monitoring is not inferior to a similar protocol including GRV
monitoring.