Paediatric intensive care nurses' decision-making around gastric residual volume measurement
Lyvonne N Tume1, Lynne Latten2, Lindsay Kenworthy2
1Alder Hey Children's NHS FT and University of Central Lancashire, Eaton Rd, Liverpool L12 2AP, UK.
Insights
Paediatric intensive care nurses rely heavily on gastric residual volume (GRV) measurements to guide enteral feeding decisions, despite limited evidence. This practice may hinder nutrition delivery in critically ill children.
Area of Science:
- Critical Care Medicine
- Pediatric Nursing
- Nutritional Support
Background:
- Gastric residual volume (GRV) measurement is a common practice in pediatric intensive care units (PICUs) to guide enteral feeding.
- Evidence supporting GRV's effectiveness is limited, and it may contribute to inadequate energy delivery in critically ill children.
Purpose of the Study:
- To explore the decision-making processes of pediatric intensive care nurses regarding GRV measurement and its influence on enteral feeding practices.
- To understand nurses' rationale, perceived harms, and concerns associated with GRV measurement in critically ill children.
Main Methods:
- A cross-sectional electronic survey was conducted among nurses in a UK mixed general and cardiac surgical PICU.
- The survey assessed nurses' experiences, reasons for GRV measurement, perceived harms, and frequency of GRV checks.
Main Results:
- Experienced nurses (mean 10.5 years) frequently measured GRV, often before every feed (58%), primarily to assess 'feed tolerance' (97%).
- Key reasons for withholding feeds included high GRV (67%), aspirate appearance (40%), and clinical condition (23%).
- Nurses expressed significant worry (84%) about not measuring GRV routinely, fearing pulmonary aspiration (44%), malabsorption (20%), and vomiting (19%).
Conclusions:
- Nurses' decisions on enteral feeding and 'feed tolerance' are heavily influenced by GRV measurements.
- Fears of patient harm associated with not routinely measuring GRV are prevalent among PICU nurses.
- The current reliance on GRV measurement in critically ill children warrants further research to validate its clinical utility and impact on nutritional delivery.
Background:
Measuring gastric residual volume (GRV) to guide enteral feeding is a common nursing practice in intensive care units, yet little evidence supports this practice. In addition, this practice has been shown to potentially contribute to inadequate energy delivery in intensive care, which remains a problem in critically ill children.
Aims:
We aimed to explore paediatric intensive care nurses' decision-making surrounding this practice.
Methods:
This is a cross-sectional electronic survey in a single mixed general and cardiac surgical PICU in the UK.
Results:
The response rate was 59% (91/154), and responding nurses were experienced, with a mean PICU experience of 10·5 years (SD 8·09). The three main reasons for stopping or withholding enteral feeds were: the volume of GRV obtained (67%), the appearance of this gastric aspirate (40%) and the overall clinical condition of the child (23%). Most nurses reported checking GRV primarily to determine 'feed tolerance' (97%) as well as confirming feeding tube position (94%). Nurses' perceived harms from high GRV were: the risk of pulmonary aspiration (44%), malabsorption of feeds (20%) and the risk of vomiting (19%). GRV was measured frequently in this PICU, with 58% measuring GRV before every feed, 27% measuring every 4 h and 17% measuring every 6 h. The majority of nurses (84%) stated they would be worried or very worried if they could not measure GRV routinely.
Conclusions:
PICU nurses' decision-making surrounding initiating and withholding enteral feeds and determining 'feed tolerance' remains heavily based on GRV. PICU nurses have significant fears around patient harm if they do not measure GRV routinely.
Relevance To Clinical Practice:
This nursing practice is likely to be one of the factors that impair the delivery of enteral nutrition in critically ill children, and as such, its validity and usefulness needs to be challenged and studied in future research.
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