Gastric Residual Volume Monitoring in Tube Feeding

Recommendations for GRV Monitoring

The American College of Physicians recommends routine monitoring of GRV is not necessary for all ICU patients receiving tube feeding, but should be performed in patients with feeding intolerance or those at high risk of aspiration 2
For patients requiring GRV monitoring, enteral feeding should be continued unless GRV exceeds 500 mL/6 hours 2
Fine-bore tubes (8 French) should be used in patients at risk of aspiration, such as stroke patients, as recommended by the Clinical Nutrition society 3
Patients should be positioned at 30° or more during feeding and for 30 minutes after to minimize aspiration risk, according to the Praxis Medical Insights guidelines 1

GRV monitoring is indicated during initial stabilization of tube feeding regimen (every 4 hours), as recommended by the Praxis Medical Insights guidelines 1
When patients demonstrate signs of feeding intolerance such as vomiting or regurgitation, abdominal distension and pain, or absence of bowel sounds, GRV monitoring is necessary, according to the Praxis Medical Insights guidelines 2

If GRV exceeds 200 ml, the feeding policy should be reviewed, as recommended by the Praxis Medical Insights guidelines 1
For GRV >500 mL/6 hours, temporarily hold enteral feeding, perform an abdominal examination to rule out acute abdominal complications, and consider prokinetic agents such as erythromycin, according to the Praxis Medical Insights guidelines 2

For patients with severe gastroparesis, small bowel feeding (jejunal) may be more appropriate to bypass gastric emptying issues, as recommended by the Praxis Medical Insights guidelines 1
In patients with stroke, dysphagia therapy should start as early as possible, regardless of tube feeding status, according to the Clinical Nutrition society 3
For malnourished patients, monitoring for refeeding syndrome is essential when initiating tube feeding, as recommended by the Praxis Medical Insights guidelines 1