Monitoring GRV is one way to assess gastric emptying in patients with tube feeding intolerance. Here aspirate is drawn from the stomach through the port via a small-bore feeding tube.

At some point in their education, nurses might have read a book or article by Norma Metheny, PhD, RN, FAAN, long considered an expert on fluid and electrolytes and tube feedings. She’s been researching tube feeding placement and assessment throughout her career—her current article in our August issue, “Monitoring Adult Patients for Intolerance to Gastric Tube Feedings,” marks her 12th publication in AJN.

Monitoring GRV.

Nurses have long been taught to check, before administering tube feedings, whether there are any residual contents remaining from the prior feeding. Monitoring gastric residual volume (GRV) was a key indicator to determine gastric emptying and thereby reduce the chance of regurgitation or vomiting and aspiration pneumonia.

Intolerance to feeding, as Metheny notes in her article, can be as high as 36% in critical care patients and approximately 27% among hospitalized patients on general units.

Which guidelines to follow?

But the proliferation of recent guidelines from various professional bodies is contradictory—no less than six groups have guidelines, some of which conflict in certain areas. One of these areas of disagreement between guidelines is about whether GRV should be used.

In this article, Metheny lays out the evidence and the controversy, and importantly, provides context based on her years of research so nurses can evaluate if and when GRV monitoring should be used.

She also covers many other topics related to enteral feeding, and includes special considerations for monitoring tube feedings in adults with COVID-19.

The article is free to read (and worth 2.0 hours of continuing professional education), and well worth it for all nurses who administer—or teach others to administer—tube feedings.

(You can listen to Dr. Metheny discuss the article and her recommendations in a podcast conversation I had with her.)