In a postoperative patient with documented high gastric residual volumes who is receiving bolus feedings, which strategy is most likely to improve feeding tolerance?

• A. Holding every other feeding
• B. Placing a small bowel feeding tube for continuous feeding
• C. Prone positioning
• D. Starting cisapride to aid motility

Answer: (B)

When gastric residuals are high with bolus feedings after surgery, the problem is often impaired gastric emptying and intolerance to large-volume stomach feeds. Delivering nutrition beyond the stomach into the small intestine using a post-pyloric (small bowel) tube and doing so as a continuous infusion bypasses the stomach, which directly reduces residual accumulation and lowers the risk of regurgitation and aspiration. This approach provides a steadier rate of caloric delivery and is typically better tolerated than intermittent boluses when gastric emptying is delayed.

Holding feedings or continuing boluses doesn’t address the underlying intolerance and can worsen nutritional短 intake. Prone positioning isn’t a reliable method to improve feeding tolerance. Prokinetic therapy like cisapride can help by enhancing motility, but safety concerns (such as QT prolongation and drug interactions) limit its use. Therefore, shifting to post-pyloric continuous feeding best improves tolerance in this scenario.