Checking Gastric Residual Volumes: A Practice in Search of Science? NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #67

T he practice of aspirating gastric residual volumes (GRV) mysteriously appeared in nursing texts several decades ago, years after enteral nutrition (EN) surfaced as a feeding modality and became the standard of practice. It is difficult to trace the origins of the practice to actual clinical data or a formalized study. The basic premise behind assessing GRVs is founded on several presumptions: 1) the belief that the practice helps distinguish normal from abnormal gastric emptying; 2) the concept that elevated GRVs only occur in situations of delayed gastric emptying and thereby indicates retention of enteral formula; 3) the assumption that accumulation of EN within the stomach, leads to aspiration; and 4) that aspiration of gastric contents invariably results in pneumonia. As a result of this line of thinking, elevated GRVs often lead to inappropriate cessation of EN. Ironically, very little scientific data exists to support any one of these presumptions. And because of the practice of GRVs, patients end up receiving less EN and their risk for pneumonia may actually increase (1–3). This article will review what is known about GRV from a physiologic as well as a clinical practice perspective. Checking Gastric Residual Volumes: A Practice in Search of Science? NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #67