Gastric residual volume (GRV) is the liquid content remaining in a person’s stomach, measured in individuals receiving nutrition or medication via a feeding tube. This measurement assesses stomach emptying and tolerance to feeding regimens.
Understanding Gastric Residual Volume
GRV represents fluid remaining in the stomach from previous feedings or natural secretions. This can include undigested formula, food, gastric juices, and medications. While some residual volume is normal, it becomes clinically relevant when suggesting delayed stomach emptying. This indicates how efficiently the stomach processes contents and moves them into the small intestine.
Why Measuring GRV is Important
Healthcare professionals measure GRV to assess a patient’s tolerance to enteral (tube) feedings and identify delayed gastric emptying. A key concern is the risk of aspiration, where stomach contents might be inhaled into the lungs, particularly for critically ill patients. This measurement guides adjustments to feeding rates or volumes, helping prevent complications and support adequate nutrition.
The Measurement Process
The process of measuring gastric residual volume involves using a syringe to withdraw fluid from a feeding tube, such as a nasogastric tube or a gastrostomy tube. Healthcare providers aspirate the contents, noting the volume obtained. It is generally recommended to return the aspirated volume to the patient’s stomach to prevent fluid and electrolyte imbalances, unless there is a specific medical reason not to. The frequency of measurement can vary in clinical practice, sometimes performed before each feeding in bolus regimens or every few hours for continuous feeds.
What Elevated GRV Indicates and How It’s Managed
What Elevated GRV Indicates
An elevated GRV typically signifies a volume exceeding a certain threshold, though these thresholds can vary by institution and patient condition. Historically, volumes above 200-250 mL have been a common point of concern, though some current guidelines suggest higher thresholds, such as 500 mL. An elevated GRV may indicate delayed gastric emptying, intolerance to the feeding regimen, or an underlying gastrointestinal issue. A single high GRV does not always predict intolerance, and subsequent measurements may decrease.
How It’s Managed
Management strategies for elevated GRV are individualized and depend on the patient’s overall clinical picture. Common interventions include temporarily pausing or slowing down enteral feedings to allow the stomach to empty. Healthcare providers may also consider administering pro-motility agents, which are medications designed to enhance gastric emptying. Additionally, they assess for contributing factors such as certain medications, the patient’s position, and other signs of feeding intolerance like nausea or abdominal discomfort. The healthcare team is typically notified to collaboratively determine the most appropriate course of action, ensuring patient safety and continued nutritional support.