Margot - Re: GRV - we never check them routinely (hasn't been our practice in > 15 y)
Karen - Re: ND tubes and free water. I wonder if the reference to 150 mL free water was based on that old case report (>10 y ago) where large boluses of distilled water were administered in a jejunally fed burn patient? We give 150-200 mL boluses of sterile water for the treatment of hypernatremia in stable ICU patient (i.e., not hypernatremia that may occur during fluid resuscitation from HONK/HHS or DKA).
Judy MacEachern RD CDE
Guelph General Hospital
I am not aware of good data to identify what the maximum volume of a bolus that can be safely delivered into the SB. It would be modified by how quickly it is delivered. I have not qualms about delivering 250ml as a push would probably be OK with volumes up to 500ml delivered over an hour but that is just comfort, not evidence. Perhaps you could generate the empiric evidence of safety by monitoring the volume of boluses given and any complications experienced.
John W. Drover, MD, FRCSC, FACS, CCPE
Professor and Head
Department of Critical Care Medicine
Program Medical Director, Critical Care Program
Kingston General Hospital
76 Stuart Street
Phone 613-549-6666 ext 6335
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