Enteral Feeding Residual Check Form
Document an enteral feeding residual check, the residual findings, patient tolerance, and the action taken.
Patient and Enteral Tube Identification
Patient Name
*
First Name
Last Name
Patient Identifier
Tube Type
*
Please Select
Nasogastric (NG)
Orogastric (OG)
Nasoduodenal (ND)
Nasojejunal (NJ)
Gastrostomy (G-tube)
Jejunostomy (J-tube)
Other
Tube Location / Site
*
Residual Check Details
Date and Time of Residual Check
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Residual Volume (mL)
Residual Appearance/Character
Please Select
Clear
Formula-like
Gastric-colored
Green
Brown
Bloody
Other
Residual Returned or Discarded
Returned
Discarded
Patient Tolerance and Action Taken
Patient tolerance or symptoms
*
No issues
Nausea
Vomiting
Abdominal distention
Discomfort
Other
Action taken after check
*
Continue feeding
Hold feeding
Notify clinician
Other
Notes or follow-up instructions
Submit
Should be Empty: