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org
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21
Effect of Returning versus Discarding Gastric Aspirate on the
Occurrence of GastricComplications andComfort Outcomeson
Enteral Feeding Patients

()oura Soli)an *ehair+
,e-ical.Surgical Nursing' /acult+ of Nursing',enofia 0ni1ersit+' 2g+t
3ra4soli)an5+ahoo.co)

3alia Salah 2l-3een 2l-Se-aw+
,e-ical.Surgical Nursing 3eart)ent' /acult+ of Nursing'6airo 0ni1ersit+' 2g+t
3alia4else-aw+5hot)ail.co)

Abstract
2nteral fee-ing (2/! is co))on for atients with -ifferent )e-ical health ro7le)s' the use of gastric resi-ual
1olu)e (8R&! is one of the )ost nursing ractices for )onitoring 2/. In the nursing literature' there is a wi-e
1ariation regar-ing whether the gastric asirate shoul- 7e returne- to the atient or -iscar-e-. 9herefore' the ai)
of the current stu-+ was to-eter)inethe effect of returning 1ersus -iscar-ing gastric asirate on the occurrence of
gastric co)lications an- co)fort outco)eson enteral fee-ing atients. ( sa)le of 44 atients co)lete- the
stu-+ -i1i-e- ran-o)l+ into two grous' the control grou who recei1e- the routine hosital care which was
-iscar-ing all gastric resi-ual asirate' an- the stu-+ grou who recei1e- returne- gastric asirate u to 2"# )l'
all atients were followe- u for :consecuti1e -a+s. 9he stu-+ was con-ucte- in two )e-ical -eart)ents of one
of the ,inistr+of ;ealth ;ositals at 6enter region (<ing-o) of Sau-i (ra7ia!. /our tools were alie- for the
stu-+' socio--e)ograhic an- )e-ical -ata sheet' gastric an- associate co)lications with tu7e fee-ing sheet'
electrol+te an- glucose )onitoring sheet = co)fort outco)es sheet. 9he stu-+ results showe- that there was no
statistical significant -ifference 7etween stu-+ an- control grous in relation to gastric resi-ual 1olu)e' fee-ing
intolerance' asiration neu)onia' electrol+tes )onitore- (so-iu)= otassiu)!' glucose le1el'
te)erature=7loo- ressure an- o>+gen saturation in the 1
st
= :
th
-a+. In a--ition' the results showe- that there
was a statistical significant -ifference 7etween stu-+ = control grous in relation to gastric e)t+ing -ela+ in the
:
th
-a+' the stu-+ grou ha- less )ean le1el than control grou' )oreo1er' there was a statistical significant
-ifference in ulse an- resiration a)ong control grou 7efore an- after fee-ing roce-ure. *ase- on the stu-+
results' it is reco))en-e- to return gastric asirate u to 2"# )l to the atients as it ha- no in-icate-
ris?forgastric an- associate co)lications as well as co)fort outco)es when co)are- to -iscar- gastric
asirate. In a--ition' further researches can 7e -one to )easure -ifferent a)ounts of returning gastric asirate
an- its effect on atient@s outco)es.
Key ordsA enteral fee-ing' gastric resi-ual 1olu)e' gastric e)t+ing -ela+' co)fort outco)es' returning 1ersus
-iscar-ing gastric asirate= gastric co)lications

!" #ntroduction
2nteral fee-ing (2/! is consi-ere- an integral art of )anage)ent of )an+ atients with -ifferent )e-ical health
ro7le)s an- the referre- )etho- of nutritional suort (*rown et al.' 2#12!. (-)inistration 1ia the
gastrointestinal tract (8I9! is less e>ensi1e an- )ore h+siologic than arenteral nutrition' in a--ition' enteral
nutrition hels to )aintain the structure an- function of the intestinal )ucosa' re-uces infection ris?s' -ecrease-
costs an- length of hosital sta+ as well as a1oi- otential a-1erse outco)es of arenteral nutrition
(,oreia=,cBuiggan' 2##$!. (lthough enteral fee-ing is consi-ere- safe an- cost effecti1e roce-ure' it is not
without co)lications that can usuall+ 7e a1oi-e- or )anage- 7+ closel+ o7ser1ing gastric resi-ual 1olu)e
(8R&! an- watching for signs an- s+)to)s of gastric intolerance (Steele =Sa7ol' 2##$!.
8R& is the a)ount asirate- fro) the sto)ach (;urt = ,c6la1e' 2#14!' it in-icates that the 8I9 is functioning
nor)all+.9he ractice of 8R& )onitoring was originall+ -esigne- to hel re1ent gastric e)t+ing -ela+'
whereas' enteral nutrition often is co)licate- 7+ intolerance as in-icate- 7+ ele1ate- 1olu)es of asirate-
gastric resi-uals which )a+ lea- to increase in the otential for regurgitation' 1o)iting an- a -ela+ in the
achie1e)ent of nutritional goals 7ecause of un-er -eli1er+ of fee-s' in a--ition to occurrence of asiration
neu)onia (Cillia)s = Deslie' 2##4!.So' in the clinical ractice 8R& is use- as a surrogate for gastric )otilit+
an- re)ains the )ost co))on )etho- for assess)ent of enteral nutrition tolerance in atients with enteral
fee-ing (,oreia=,cBuiggan' 2##$ an- Ealoga' 2##"!.In the literature' there is a wi-e 1ariation in the 1alue for
nor)al 8R&' so)e reorte- that it was 7etween 1## to 1"# )l (,onteFo' ,ina)7res' = *or-eFe' 2##8! others
consi-ere- it u to 2"# )l (,arshal = Cest' 2##6!.It is reco))en-e- that 8R&s 7e )onitore- e1er+ 4 to 8
hours an- one e1ent of ele1ate- 8R& shoul- not ro)t cessation of enteral tu7e fee-ing (Johnson' 2##$!.
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8astric e)t+ing -ela+ was -efine- as the -ifficult+ in )aintaining gastric resi-ual 1olu)e within safe
li)its.,ethen+' Schallo)' an- 2-war-s (2##4! )entione- that clinicall+8R&is easier to )easure than gastric
e)t+ing. 8R& )easure)ents are 7+ far the )ost freGuentl+ reco))en-e- assess)ent for gastric e)t+ing. So
the+ha1e use- 8R& as a surrogate )ar?er to -eter)ine gastric e)t+ing -ela+. ,oreo1er' Ju1e-0-ina et al.'
(2##$! reorte- that the regular chec?ing of 8R& 7+ asiration with a s+ringe isa co))on nursing inter1ention
to assess gastrointestinal function an- to )ini)iHe otential co)lications fro) enteral nutritional thera+.
(lthough it is h+othesiHe- that high 8R& lea-s to gastric e)t+ing -ela+ which )a+ lea- to asiration
neu)onia (,oreira =,cBuiggan' 2##$ an- 6hang et al.' 2##:!'7ut' Stu-ies -irectl+ co)aring gastric
e)t+ing -ela+ with 8R& ha1e shown oor correlation. In stu-ies using the araceta)ol a7sortion test as a
)easure of gastric e)t+ing' Dan-Hins?i' et al.' (2##8!an- Parrish = ,c6la1e' (2##8! showe- that in atients
-eter)ine- to 7e intolerant with high 8R& (-efine- 7+ a single 8R& I 1"# )l!' 1##Jha- a7nor)al gastric
e)t+ing. In contrast to the atients -eter)ine- to 7e tolerant with low 8R& (-efine- 7+ all 8R& K 1"# )l!'
still :# J ha- a7nor)al gastric e)t+ing. ( thir- stu-+ showe- that 2" J of intolerant atients with high 8R&
ha- nor)al gastric e)t+ing(Roh)' *ol-t' = Pier' 2##$!. (nother stu-+ re1eale- that ":J of tolerant atients
with nor)al 8R& ha- a7nor)al gastric e)t+ing. 9hese stu-ies confir) that 8R& are inaccurate an- unrelia7le
in-icator for e)t+ing -ela+ (;urt =,c6la1e' 2#1#!.
,oreo1er' the relationshi 7etween high 8R& an- asiration neu)onia is wea?. (siration -efine- as the
inhalation of )aterial into the airwa+' is the )ain cause of neu)onia. ( rosecti1e stu-+ foun- that high
asirate- resi-ual 1olu)es were an earl+ in-icator of fee-ing intolerance' which was associate- with higher rates
of neu)onia (,oreia=,cBuiggan' 2##$!. *+ contrast' ,c6la1e et al. (2##"! in their stu-+ e)hasiHe- that
low resi-ual 1olu)es -i- not -ecrease the ris? of asiration an- neu)onia.
<aur et al.' (2#12! state- that the with-rawal of gastric Fuice woul- in-uce a seGuence of )eta7olic changes
which )a+ affect the electrol+te 7alance. ( stu-+ con-ucte- on atients a-)itte- for surgical inter1entions )a-e
continuous with-rawal of gastric contents through an in-welling gastric tu7e attache- to gastric suction' foun-
that seru) so-iu) -roe- as well as otassiu). 9he stu-+ a--e- that this can 7e re1ente- 7+ reintro-uction of
asirate- gastric contents (3a1i-' 2#11!.
In the light of this resentation' it can 7e conclu-e- that to return or to -iscar- gastric asirate is a contro1ersial
issue in nursing ractice. 9he ractice of returning gastric asirate is Fustifie- 7+ the 7elief that continual
re)o1al of gastric contents will contri7ute to alterations in 7o-+ functions(,arshall an- Cest' 2##6!. Chile'
*ourgault' et al.' (2##:!suggeste- that -iscar-ing gastric asirates )a+ re1ent co)lications.
1.2Significance of the study
9he literature re1iew showsa wi-e 1ariation in nursing ractices regar-ing the gastric asirate' there is no
nursing stan-ar-s a7out whether the gastric asirate shoul- 7e returne- to the atient or-iscar-e-(ullen'
2##4an- Cillia)s = Deslie' 2##4!. So)e nurses -iscar- gastric contents while others reintro-uce it to the
atient' artiall+ or co)letel+' -een-ing on their assess)ent (,arshall an- Cest' 2##6!' unit tra-ition or
routine. In-i1i-ual 7eliefs an- nurse@s e>erience gui-e the -ecision whether to return or -iscar- gastric asirate.
So)e authors suort returning gastric content asirate- in or-er to contri7ute to the )aintenance of gastric
Fuices an- the electrol+te 7alance. %thers h+othesiHe -iscar-ing as the 7est otion in or-er to a1oi- -ela+e-
gastric e)t+ing as well as to re1ent asiration neu)onia secon-ar+ to gastric e)t+ing -ela+ (Ju1e-0-ina et
al.' 2##$an- Ri-le+ = 3a1ies' 2#11!.,oreo1er' there is no consensus on the a)ount of 8R& that can 7e
returne- without ris? for intragastric co)lications an- asiration neu)onia. So' it is i)ortant to erfor)
researches in this area to ha1e an e1i-ence 7ase- nursing ractice regar-ing this issue. 9herefore' the ai) of the
current stu-+ was to-eter)inethe effect of returning 1ersus -iscar-ing gastric asirate on the occurrence of
gastric co)lications = co)fort outco)eson enteral fee-ing atients.

$" %ub&ects and 'ethods
2.1 Purpose of the study
9he urose of the current stu-+ was to-eter)ine the effect of returning 1ersus -iscar-ing gastric asirate on the
occurrence of gastric co)lications = co)fort outco)eson enteral fee-ing atients.
2.2 Research design
Buasi-e>eri)ental -esign was selecte- to e1aluate the effect of in-een-ent 1aria7le (returning 1ersus
-iscar-ing gastric asirate! on the -een-ent 1aria7le (the occurrence of gastricco)lications an- co)fort
outco)es!.
2.3 Study Setting
9he stu-+ was carrie- out in twoof )e-ical -eart)ents of one of the,inistr+of;ealth ;ositals at 6enter
region (<ing-o) of Sau-i (ra7ia!.
2.4 Sample
( sa)le of 6# a-ult )ale an- fe)ale atients a-)itte- to the re1iousl+ )entione- setting was stu-ie- with the
following inclusion criteriaA (a! Patients connecte- with enteral fee-ing within first 24 hours' (7! Patients on
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&ol.4' No.1"' 2#14

23
enteral fee-ing for : consecuti1e -a+s' while e>clusion criteria inclu-es atients with gastrointestinal tract
ro7le)s or those with electrol+te -istur7ances. 9he 6# atients were ran-o)l+ eGuall+ classifie- into two
grous' the control grou' 3# atients' who ha- -iscar-ing gastric asirate (the routine hosital care! an-the
stu-+ grou' 3# atients' who ha- returning gastric asirate u to 2"# )l. 1# out of 3# atients of the control
grou an- 6 out of 3# atients of the stu-+ grou were -roe- fro) the stu-+ either 7ecause of -eath or
-iscontinue- gastric fee-ing 7efore the :
th
-a+. 9herefore the control grou who co)lete- the research was 2#
atients' an- 24 atients were in the stu-+ grou.
2.5 Tools for Data Collection
3ata were collecte- using four tools in or-er to achie1e the ai) of the stu-+. 9hese tools were -e1eloe- 7+ the
researchers after re1iewing the relate- literature. 9he tools were su7)itte- to a Fur+ of : )e)7ers who are
e>erts in the )e-ical surgical nursing fiel- an- facult+ staff )e)7ers for its content 1ali-it+. 9he 1ali-it+ for
the 1arious ite)s 1arie- 7etween 8#J = 1##J. 9he four tools wereA
1. Socio--e)ograhic an- )e-ical -ata sheetAthis art inclu-es socio--e)ograhic -ata such as age'
gen-er an- )e-ical -ata which were resent -iagnosis' ast )e-ical histor+' an- 8lasgow co)a scale.
2. 8astric an- associate co)lications with tu7e fee-ing sheetA this tool )easure-the co)ilations
regar-ing -iscar-ing 1ersus returning gastric asirate as well as associate co)lications with tu7e
fee-ing. It inclu-es ite)s relate- to gastric resi-ual 1olu)e (8R&!' gastric e)t+ing -ela+' fee-ing
intolerance (1o)iting' -iarrhea! an- occurrence of asirationneu)onia.
3. 2lectrol+te an- glucose )onitoring sheetA seru) otassiu)' so-iu) an- glucose le1el were )onitore-.
4. 6o)fort outco)es sheetA it inclu-es )easure)ent of 1ital signs (te)erature' ulse' resiration an-
7loo- ressure! as well as o>+gen saturation which )easure- 7+ ulse o>i)etr+.
2. !thical considerations
(n official er)ission was ta?en fro) the research co))ittee an- hosital a-)inistrators. (lso' each atient
an-guar-ian erson for those whose 86S is K1# was infor)e- a7out the urose an- nature of the stu-+ an-
infor)e- consent was ta?en fro) each atient an- guar-ian. 9he researchers e)hasiHe- that articiation in the
stu-+ is entirel+ 1oluntar+L anon+)it+ an- confi-entialit+ are assure- through co-ing the -ata.
2." Pilot Study
( ilot stu-+ was carrie- out on " atientswho)et the re-eter)ine- selection criteria to assess the clarit+ an-
feasi7ilit+ of the tools' the necessar+ )o-ifications were -one.9he fin-ings of the ilot stu-+ re1eale- that all of
the ite)s of the tools were clear an- feasi7leto achie1e the ai) of the current stu-+. 9he fi1e Patients were
e>clu-e- fro) the final stu-+ results.
2.# Procedure
%nce official er)ission was grante- fro) the research co))ittee an- fro) the hea- )anagers of the selecte-
hosital to rocee- with the stu-+' the researchers initiate- -ata collection. 9he+ e>laine- the urose an-
nature of the stu-+ to theatients an- guar-iansof the atients an- once er)ission was ta?en' researchers starte-
to erfor) the e>eri)ent. Patients were ran-o)l+ assigne- either to control grou or stu-+ grou 7+
consi-ering the 1
st
atient for -ata collection as control an- the secon- one as stu-+ an- so on. /or control grou'
atients recei1e- the routine hosital inter1ention which was to -iscar- all gastric asirate 7efore fee-ing' while
the stu-+ grou ha- returning gastric asirate u to 2"# )l' an+ surlus o1er 2"# )l was -iscar-e-' this a)ount
was -eci-e- 7ase- on a stu-+ -one 7+ 0-ina et al.' (2##$!' the+ reorte- that returning 2"#)l of gastric asirate
has no ris? effect on atients' in a--ition to the consultant h+sician oinion a7out the safe a)ount of returning
gastric asirate. *oth grous recei1e- inter)ittent gastric fee-ing using 6# )l s+ringe through a large 7ore
fee-ing tu7e (16 /r! to a1oi- occlusion of fee-ing tu7e' an- the )aterial of tu7e was fro) ol+urethane. In
a--ition 8R& was chec?e- routinel+ e1er+ 6 hours' for the stu-+ grou eachti)e8R&was chec?e-the atients
recei1e- the gastric asirate u to 2"# )l an- nurses notes were re1ise- to 7e sure of recei1ing gastric asirate'
while 8R& was chec?e- 7+ the researchers for 7oth grous -uring the )orning shift'asiration was -one 7efore
)eal 1ia a 6# )l s+ringe.(ll the atients ut in the se)isittingosition -uring fee-ing. (ll atients were followe-
u for : consecuti1e -a+s.Nor)al gastric resi-ual 1olu)econsi-ere- in the current researchwas fro)# . 1"# )l
an- the a)ountof)ore than 1"# )l in-icate- resence of gastric e)t+ing -ela+. 8astric e)t+ing was -i1i-e-
7ase- on the a)ountwhich e>cee-e- 1"# )l as followsA 1"1 . 2"# )l light -ela+' 2"1 . 3"# )l as )o-erate
-ela+ an- )ore than 3"# )l as se1ere -ela+.3ail+ sche-ule- la7 test (8 a.).! was o7taine- for seru) otassiu)'
so-iu)' an- glucose. 9he nor)al range of the seru) electrol+tes an- glucose accor-ing to the hosital
la7orator+ wereA otassiu) 3." . "." )2GM D' so-iu) 13" . 14" )2GMD an- glucose " . :.: ))olMD. *efore an-
after )orning 8R& chec? an- fee-ing' 1ital signs an- o>+gen saturation were assesse- to i-entif+ an+ signs of
-isco)fort in the atient -ue to the roce-ure. Patients were )onitore- for fee-ing intolerance through
occurrence of 1o)iting = -iarrhea. (siration neu)onia was in-icate- 7+ resence of shortness of 7reath'
crac?le chest soun-' -ecrease- o>+gen saturation in a--ition to )e-ical -iagnosis of asiration neu)onia.(ll
the re1ious o7taine- -ata were recor-e- in -esigne- for)at -ata sheet fro) the 1
st
-a+ to se1en consecuti1e
-a+s for all stu-ie- sa)le. 9he -ata were collecte- o1er 12 )onths.
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&ol.4' No.1"' 2#14

24
2.$ Data analysis
3ata was co-e- for entr+ an- anal+sis using SPSS statistical software ac?age 1ersion 16. 3ata was resente-
using -escriti1e statistics in the for) of freGuencies an- ercentages' )eans an- stan-ar- -e1iations. 3ata was
-escri7e- 7+ su))ar+ ta7les an- figures. 9-test =6hi sGuare were use-. Statistical significance was consi-ere-
at P-1alue N #.#".

(" Results
9a7le 1. /reGuenc+ -istri7ution of the socio--e)ograhic =)e-ical -ata 1aria7les of control = stu-+ grous
&aria7les 6ontrol8rouA2# Stu-+8rouA24
6hi-sGuare No. J No. J
(geA
18-3#
3#-
4"-
6# an- )ore

"
"
8
2

2"J
2"J
4#J
1#J

2
:
12
3

8.3J
2$.2J
"#J
12."J


2.26
8en-erA
,ale
/e)ale

11
$

""J
4"J

1:
:

:#.8J
2$.2J

1.13
Present -iagnosisA
Resirator+ -isor-er
Neurological -isor-er
6ar-iac -isor-er
;ea- or chest trau)a

"
:
4
4

2"J
3"J
2#J
2#J

"
8
6
"

2#.8J
33.3J
2"J
2#.8J


#.32
8lasgow 6o)a Scale
3 . 6
: . 1#
11 . 1"

3
6
11

1"J
3#J
""J

3
:
14

12."J
2$.2J
"8.3J


#.#8
In relation to age (4# J = "# J! of the control = stu-+ grous resecti1el+ ha- age range 7etween 4" to less
than 6# with ("" J = :#.8J! of the control = stu-+ grous resecti1el+7eing)ales.
Regar-ing )e-ical -iagnosis' neurological -isor-ers reresent (3" J = 33.3 J! of control an- stu-+ sa)le
resecti1el+. (--itionall+' 8lasgow co)a scale shows that (""J = "8.3J! of the control an- stu-+ grous
resecti1el+ ha- scoresrangingfro) 11 to 1".
9a7le (1! shows that there was no statistical significant -ifference 7etween 7oth grous in relation to socio-
-e)ograhic 1aria7les an- )e-ical -ata.

O9his 1aria7le is )utuall+ e>clusi1e
/igure 1. Percentage -istri7ution of ast )e-ical histor+ a)ong control an- stu-+ grous
50%
30%
10%
0%
35%
58.30%
33.30%
4.20%
16.70%
37.50%
0%
10%
20%
30%
40%
50%
60%
70%
No past history Cardiovascular
disorder
Respiratory
disorder
Neurological
disorder
ia!etes "ellitus
Co#trol group $tudy group
Journal of Natural Sciences Research www.iiste.org
ISSN 2224-3186 (Paer! ISSN 222"-#$21 (%nline!
&ol.4' No.1"' 2#14

2"
Regar-ing ast )e-ical histor+' ("# J = "8.3 J! a)ong control an- stu-+ grous resecti1el+ ha- no ast
)e-ical histor+. In a--ition' (3" J = 3:." J! of the control an- stu-+ grous resecti1el+ ha- -ia7etes. 9here
was no statistical significant -ifference 7etween control an- stu-+ grous regar-ing ast)e-ical histor+.
9a7le 2. /reGuenc+ -istri7ution = co)arison of )eans in relation to gastric an- associate co)lications of tu7e
fee-ing7etween control = stu-+ grous.
&aria7les 1
st
-a+ :
th
-a+
6ontrol Stu-+ 6ontrol Stu-+
8astric resi-ual 1olu)eA
# . 1"# )l
I 1"# )l
P Q S3

12
8
13" Q 4".2

1"
$
131.3Q3:."

11
$
142."

1:
:
128.:
t-test #.2$1 1.1:
8astric e)t+ing -ela+A
Nu)7er of atients
Dight(1"1-2"#!
,o-erate (2"1-3"#!
Se1ere (I3"#!
P Q S3

8 (4#J!
"
3
#
244.4Q":.8

$ (3:."J!
:
2
#
241.:Q"".$

$ (4"J!
6
3
#
23:."Q"4.1

:(2$.2J!
"
2
#
2#8.6Q36.8
t-test #.1"6 2.#3O
(siration neu)oniaA
Res
No

2
18

2
22

#
2#

1
23
6hi . sGuare #.#43 1.#2
9a7le (2! shows that there was no statistical significant -ifference 7etween stu-+ = control grous in relation to
8R&' gastric e)t+ing -ela+ an- asiration neu)onia in the 1
st
-a+. Chile in the :
th
-a+' there was a statistical
significant -ifference 7etween stu-+ = control grous in relation to gastric e)t+ing -ela+ (t-testA 2.#3!.

/igure 2. /reGuenc+ -istri7ution of fee-ing intolerance in-icators (1o)iting = -iarrhea! a)ong stu-+ an-
control grous -uring 1
st
= :
th
-a+s.
/igure (2! shows that onl+ 2 atients(less than " J! of the total stu-ie- sa)le ha- fee-ing intolerance in-icators
in the :
th
-a+ with no statistical significant -ifference 7etween stu-+ an- control grous either in the 1
st
or the :
th

-a+.
1
3
1
0
2 2
0
1
0
0.5
1
1.5
2
2.5
3
3.5
%o"iti#g iarrhea %o"iti#g iarrhea
1st day 7th day
Co#trol group $tudy group
Journal of Natural Sciences Research www.iiste.org
ISSN 2224-3186 (Paer! ISSN 222"-#$21 (%nline!
&ol.4' No.1"' 2#14

26
9a7le 3. /reGuenc+ -istri7ution an- co)arison of )eans in relation to the electrol+tes = glucose 7etween stu-+
= control grous

&aria7les
1
st
-a+ :
th
-a+
6ontrol Stu-+ 6ontrol Stu-+
Potassiu)A
Nor)al
(7o1e nor)al
*elow nor)al
P Q S3

12
3
3
4.4$ Q .$8

16
2
6
4.3: Q 1

18
1
1
4." Q 1.1

23
#
1
4.1 Q #.6
t-test #.4# 1.33
So-iu)A
Nor)al
(7o1e nor)al
*elow nor)al
P Q S3

16
2
2
142 Q 16.:

2#
3
1
141.1 Q 1#."

2#
#
#
141 Q 24.2

23
#
1
13$.3 Q 14.1
t-test #.21 #.2:
8lucoseA
Nor)al
(7o1e nor)al
*elow nor)al
P Q S3

1"
"
#
:.6 Q 3.8

2#
3
1
6.$ Q 3.$

1:
3
#
6.8 Q 2.$

22
2
#
6." Q 1."
t-test #.6# #.42
In relation to electrol+te = glucose le1el' ta7le (3! re1eale- that there was no statistical significant -ifference
7etween stu-+ = control grous either in the 1
st
-a+ or 7+ the en- of the :
th
-a+.
9a7le 4. /reGuenc+ -istri7ution an- co)arison 7etween 7efore an- after tu7e fee-ing roce-ure a)ong control
grou an- stu-+ grou in relation to co)fort outco)es (1ital signs an- o>+gen saturation!
&aria7les 1
st
-a+ :
th
-a+
6ontrol Stu-+ 6ontrol Stu-+
*efore (fter *efore (fter *efore (fter *efore (fter
9e)eratureA
Nor)al
(7o1e nor)al
*elow nor)al
P Q S3

13
4
3
3:.2 Q#.$

13
4
3
3:.2$Q#.$

1$
"
#
3:."Q1

1$
"
#
3:." Q 1

18
2
#
3:.6Q#.$

18
2
#
3:.6 Q#.$

18
3
3
3:.2Q#.8

18
3
3
3:.2Q#.8
t-test .321 # # #
PulseA
Nor)al
(7o1e nor)al
*elow nor)al
P Q S3

1:
3
#
88.:Q1".:

14
6
#
$8.$Q14."

16
8
#
81.8Q1".$

1"
$
#
8$.$Q16.1

16
4
#
8"Q18.3

12
6
#
$:.1Q14.$

2#
4
#
$3.8Q14.:

1$
"
#
$:.6Q1".8
t-test 2.1:O 1.:6 2.2$O #.86
ResirationA
Nor)al
(7o1e nor)al
*elow nor)al
P Q S3

18
1
1
1$."Q3.$

1:
3
#
2#.1Q4.2

1$
4
1
21Q 4."

2#
4
#
21.8Q4.3

2#
#
#
21Q1.4

18
2
#
22.6Q1.$

2#
3
1
22.4Q3.$

2#
3
1
22.6Q3.$
t-test #.468 #.634 3.#:O #.1:8
*loo-
ressureA
Nor)al
(7o1e nor)al
*elow nor)al

12
"
3

12
"
3

16
"
3

16
"
3

13
:
#

13
:
#

16
"
3

1:
"
2
6hi .sGuare # # # #.24
%>+gen
saturationA
Nor)al
(7o1e nor)al
*elow nor)al
P Q S3


2#
#
#
$:.$Q2


2#
#
#
$:.6Q 2


23
#
1
$:.3Q3.2


23
#
1
$:.1Q3.2


2#
#
#
$8."Q#.:


2#
#
#
$8."Q#.:


24
#
#
$:.2Q2.8


24
#
#
$:.1Q2.8
t-test #.4:6 #.21: # #.12"
9a7le (4! shows that' there was a statistical significant -ifference 7efore an- after tu7e fee-ing in relation to
ulse -uring the 1
st
= :
th
-a+s a)ong control grou. In a--ition' in the :
th
-a+ there was a statistical significant
-ifference 7efore an- after tu7e fee-ing regar-ing resiration a)ong control grou. Chile' there was no
Journal of Natural Sciences Research www.iiste.org
ISSN 2224-3186 (Paer! ISSN 222"-#$21 (%nline!
&ol.4' No.1"' 2#14

2:
statistical significant -ifference in 1ital signs an- o>+gen saturation 7efore an- after roce-ure a)ong the stu-+
grou -uring 1
st
= :
th
-a+.

)" Discussion
It is a routine ractice in )an+ hositals that gastric asirate is -iscar-e- 7efore gi1ing each fee-. 9herefore' the
ai) of the current stu-+ was to -eter)ine the effect of returning 1ersus -iscar-ing gastric asirate on the
occurrence of gastric co)lications = co)fort outco)es on enteral fee-ing atients. (44!Patients co)lete- the
current stu-+ (2# atients in control grou = 24 in stu-+ grou!. 9he stu-+ results re1eale- that a7out two thir-s
of 7oth stu-+ = control grous ha- age ranging7etween 3# to less than 6# +ears. ,ore than half of the stu-ie-
sa)le were)ales. ,oreo1er' a7out one thir- ha- neurological -isor-ers with )ore than half of the sa)le
ha1ing8lasgow 6o)a Scale I11 score. 9he stu-+ an- control grous see) to 7e ho)ogeneous grous whereas
there was no statistical significant -ifference 7etween 7oth grous in relation to socio--e)ograhic 1aria7les an-
)e-ical -ata.
Regar-ing 8R&' the stu-+ results conclu-e- that there was no statistical significant -ifference 7etween stu-+ =
control grou in 7oth 1
st
=:
th
-a+ in-icating that returning gastric asirate to the atient in the stu-+ grou -i- not
increase 8R& in co)arison to -iscar-ing gastric asirate in the control grou.9he fin-ing of the current
research is congruent with a stu-+ -one 7+ Ju1e-0-ina et al.' (2##$! on 63 atients to e>a)ine whether to return
or to -iscar- gastric asirate'who foun- that there was no statistical significant -ifference 7etween inter1ention
grou (returning grou! an- control grou (-iscar-ing grou! in relation to 8R&. ,oreo1er' se1eral stu-ies were
-one on 8R& an- none of the) foun- an association 7etween high 8R& an- co)lication rate (<uinger et al.'
2#13!.
Regar-ing gastric e)t+ing -ela+' the stu-+ results conclu-e- that there was no statistical significant -ifference
7etween stu-+ = control grous in the 1
st
-a+' while in the :
th
-a+' there was a statistical significant -ifference
7etween the) with -ecrease- )ean of gastric e)t+ing a)ount in the stu-+ grou when co)are- to control
grou. In a--ition' the stu-+ results foun- that there was no statistical significant -ifference 7etween stu-+ an-
control grous regar-ing fee-ing intolerance signs (1o)iting = -iarrhea! in the 1
st
= :
th
-a+. 9he researchers
)a+ interret these fin-ings that returning gastric resi-ual 1olu)e that ha- a artiall+ -igeste- foo- an- gastric
Fuice )a+ enhance faster -igestionwhich )a+ -ecrease gastric e)t+ing a)ount. 9he stu-+ results co)e into the
sa)e line with <aur et al. (2#13! who stu-+ the effect of reintro-uction of asirate- gastric content on gastric
e)t+ing in atients recei1ing gastric fee-ing' foun- that )ore su7Fects in test grou (recei1e the gastric asirate!
were in nor)al range of gastric e)t+ing co)are- to control grou (-iscar-e- gastric asirate!' in a--ition'
fee-ing intolerance ha- no statistical significant -ifference 7etween 7oth grous' the stu-+ conclu-e- that
reintro-uction of gastric asirate ha- no effect on gastric e)t+ing.,oreo1er' ;urt =,c6la1e (2#1#!)entione-
two stu-ies were -one on -iscar-ing 1ersus returning gastric asirate' in the 1
st
stu-+ atients were ran-o)iHe-
to ha1e the 8R& returne- or -iscar-e- an- the+ conclu-e- that no significant -ifference was seen in relation to
gastric e)t+ing -ela+' asiration neu)onia = electrol+te a7nor)alities. 9he 2
n-
stu-+ -one on 12" atients to
ha1e the 8R& returne- or -iscar-e-'showe- thatthe se1erit+ an- inci-ence of -ela+e- gastric e)t+ing was
significantl+ lower in the returning grou than -iscar-ing grou' )oreo1er fee-ing intolerance ha- no statistical
significant -ifference 7etween the two grous. (;urt' = ,c6la1e' 2#1#!.
In relation to asiration neu)onia' the results conclu-e- that there was no statistical significant -ifference
7etween stu-+ = control grous in the 1
st
= :
th
-a+s. 9he stu-+ results congruent with the stu-+ -one 7+ Ri-le+
= 3a1ies (2#11! who )entione- in their stu-+ that there was no -ifference in asiration neu)onia when
atients with a high 8R& threshol- were co)are- to a low 8R& threshol-.,oreo1er' a stu-+ -one on 2#6
criticall+ ill atients recei1ing gastric enteral tu7e fee-ing' atients were -i1i-e- into three grous 7ase- on
highest 8R& o7taine-A I 1"# )l' I 2## )l' an- I 2"# )l' the authors state- that the+ foun- no consistent
relationshi 7etween 8R& an- asiration (,ethen+' et al.' 2##8!.
It is 7elie1e- that -iscar-ing gastric asirate )a+ result in loss of electrol+tes' 7ut this coul- not 7e 1erifie- with
the results of current stu-+' as this stu-+ coul- not fin- an+ statistical significant -ifference 7etween stu-+ =
control grous in relation to electrol+te (otassiu) = so-iu)! an- glucose in the 1
st
= :
th
-a+s. ( stu-+ -one on
the effect of reintro-uction of asirate- gastric content on seru) electrol+te le1el agree- with the current stu-+
result which foun- that seru) so-iu) an- otassiu) le1els -i- not change significantl+ in grou of gastric
asirate intro-uction an- the grou of gastric asirate -iscar-ing (<aur et al.' 2#12!. ,an+ interretations)a+
e>lainthese fin-ings' one of the) is that the+ )a+ 7e 7ecause of the intra1enous solutions that the atients
recei1e which )a+ contri7ute to ?ee seru) electrol+te within nor)al' another researchers@ e>lanation )a+ 7e
-ue to the a7ilit+ of the 7o-+ to co)ensate the electrol+te loss through -ifferent )echanis)s such as renal re-
a7sortion.
In relation to co)fort outco)es thatwere )easure- 7+ 1ital signs an- o>+gen saturation' the stu-+ results foun-
that there was a statistical significant -ifference a)ong control grou regar-ing ulse in the 1
st
=:
th
-a+s an- in
resiration in the :
th
-a+. %n the other han-' there was no statistical significant -ifference in the stu-+ grou in
Journal of Natural Sciences Research www.iiste.org
ISSN 2224-3186 (Paer! ISSN 222"-#$21 (%nline!
&ol.4' No.1"' 2#14

28
relation to co)fort outco)es'in-icating that the roce-ure of returning gastric asirate )a+ not -isco)fort the
atient. 9he stu-+ results contra-icte- with fin-ings of the stu-+ -one 7+ 0-ina et al.' (2##$! which conclu-e-
that no statistical -ifference was i-entifie- in relation to the -isco)fort outco)es which were also )easure- 7+
1ital signs a)ong the control grou an- stu-+ grou.

*" Conclusion
In the light of these results' it can 7e conclu-e- that returning asirate- gastric content u to 2"# )l -oes not
contri7ute to gastric an- associate co)lications as )easure- 7+ gastric resi-ual 1olu)e' gastric e)t+ing
-ela+' fee-ing intolerance as well as asiration neu)onia. In a--ition returning or -iscar-ing gastric asirate
ha- no significant effect on electrol+te (so-iu) = otassiu)! an- glucose le1el. ,oreo1er' returning gastric
asirate roce-ure ha- no in-icate- ris? for -isco)forting the atients.

+" Recommendation
*ase- on the results of the resent stu-+ the following reco))en-ations are suggeste-
- (s returning gastric asirate u to 2"# )l ha- no in-icate- ris? for the atients therefore it is
reco))en-e- to inclu-e it as a nursing ractice when caring for atients with 2/.
- In a--ition' further researches can 7e -one to )easure -ifferent a)ounts of returning gastric asirate
an- its effect on atient@s outco)es.
- Prosecti1e stu-ies shoul- 7e -one to -eter)ine the 7enefit of returning gastric asirate to the 2/
atients.

," Ac-noledgement
9he authors wish to e>ress their -eeest areciation an- sincere gratitu-e to rof. Saleh (l-a)egh' 3ean of
6ollege of ,e-icine an- ,e-ical Sciences = ,rs. Eaina7 (l-Cash)i' &ice -ean of 6ollage of ,e-icine an-
,e-ical Sciences' %niHah' Bassi) 0ni1ersit+. In articular she woul- li?e to than? all nurses in ,e-ical
3eart)ent who so generousl+ offere- their e>eriences' effort an- ti)e on collection of this -ata. %n to of
the) ,iss 9agree- (D;ar7i' staff nurse for heling an- cooeration in collecting this -ata. (n- cannot forget to
than? clinical instructor' ,rs. 2)an (l She)ri in 6ollege of ,e-icine an- ,e-ical Sciences' %niHah' Bassi)
0ni1ersit+' <S( for heling an- cooeration@s in fulfilling this stu-+.

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Journal of Law, Policy and Globalization JLPG@iiste.org
Journal of New Media and Mass Communication NMMC@iiste.org
Journal of Energy Technologies and Policy JETP@iiste.org
Historical Research Letter HRL@iiste.org
Public Policy and Administration Research PPAR@iiste.org
International Affairs and Global Strategy IAGS@iiste.org
Research on Humanities and Social Sciences RHSS@iiste.org
Journal of Developing Country Studies DCS@iiste.org
Journal of Arts and Design Studies ADS@iiste.org