Nurses' decision‐making around gastric residual volume measurement in UK adult intensive care: A four‐centre survey

Abstract

AbstractBackgroundDespite increasing evidence of the potential inaccuracy and unwarranted practice of regular GRV measurement in critically in adults, this practice persists within the United Kingdom.AimTo explore adult intensive care nurses' decision‐making around the practice of GRV measurement to guide enteral feeding.Study DesignA cross‐sectional 16 item electronic survey in four adult intensive care units (ICUs) in England and Wales.ResultsTwo hundred and seventy‐three responses were obtained across four ICUs with acceptable response rates for most [Unit 1 74 /127 = 58.2%; Unit 2 87/129 = 67.4%; Unit 3 77/120 = 64.1%; Unit 4 35/168 = 20.8%]. Most (243/273 (89%) reported measuring GRV 4–6 hourly, with most (223/273 82%) reporting that the main reason was to assess feed tolerance or intolerance and 37/273 (13.5%) saying their unit protocol required it. In terms of factors affecting decision‐making, volume obtained was the most important factor, followed by the condition of the patient, with aspirate colour and appearance less important. When asked how they would feel about not measuring GRV routinely, the majority (78.2%) of nurses felt worried (140/273 = 51.2%) or very worried (74/273 = 27%).ConclusionsFactors affecting the nurses' decision‐making around GRV were based largely on fear of risk (around vomiting and pulmonary aspiration) and compliance with unit protocols.Relevance to Clinical PracticeDespite increasing evidence suggesting it is unnecessary, nurses' beliefs around the value of this practice persist and it continues to be embedded into unit protocols around feeding.