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by Kymmi

Please explain to me why is it that nurses fail to use any common sense or stop to think about why they do the things they do.....for example, exactly what do you accomplish by stopping tube feeding; (whether DHT, Peg Tube, G-Tube, NGT) for 60 seconds while making a pt. supine in order to reposition them in bed, then sitting them back up to resume the Tube Feeding. With a Tube Feeding rate of 60cc/hr, that would prevent 1 cc from infusing......this will hardly prevent aspiration. The Tube Feeding should be stopped 1 hour in advance, then residual should be checked prior to putting a pt in supine postion......I'm sure that is what everyone is doing.......the old phrase 'well that's what everyone else does'.......just ain't good enough.......

[CritterLover]

Re: 60 Second Tube Feed Stop********

I think the reasoning is in case the tube (dobhoff, ng, whatever) becomes disloged/migrates while the patient is being turned/moved.

As for the peg tubes, many things we do are based out of habit. It doesn't hurt anything to stop the tfs for 60 seconds, so why not stay in the habit.

[Kymmi]

Re: 60 Second Tube Feed Stop********

You're telling me that stopping tube feeding for 60 seconds is some how going to prevent tube migration......and I'm sure you recheck tube position every time you reposition your pt.......the only accurate way to ensure tube position.........and the reason we 'break the habit' is because it is not an effective technique.....

[Kymmi]

Re: 60 Second Tube Feed Stop********

I think that the lemmings last words were "Why not stay in the habit"

[nyapa]

Re: 60 Second Tube Feed Stop********

[quote=Kymmi;2283047]Please explain to me why is it that nurses fail to use any common sense or stop to think about why they do the things they do.....for example, exactly what do you accomplish by stopping tube feeding; (whether DHT, Peg Tube, G-Tube, NGT) for 60 seconds while making a pt. supine in order to reposition them in bed, then sitting them back up to resume the Tube Feeding. With a Tube Feeding rate of 60cc/hr, that would prevent 1 cc from infusing......this will hardly prevent aspiration. The Tube Feeding should be stopped 1 hour in advance, then residual should be checked prior to putting a pt in supine postion......I'm sure that is what everyone is doing.......the old phrase 'well that's what everyone else does'.......just ain't good enough.......[/QUOTE

As I understand the maximum time you should leave a fully dependent patient before they are being turned is two hours. Wouldn't turning the feed off 1 hour beforehand mean that the patient only gets half their prescribed intake?

[lsyorke]

Re: 60 Second Tube Feed Stop********

Originally Posted by dar15

As I understand the maximum time you should leave a fully dependent patient before they are being turned is two hours. Wouldn't turning the feed off 1 hour beforehand mean that the patient only gets half their prescribed intake?

Yup, which is why turning off for an hour is rarely done. Sometimes optimal practice and real life just don't work together. Plus if you are turning off a feeding for an hour, you're going to have to flush the tube, which adds even more fluid to the stomach...increasing the aspiration threat.

[BBFRN]

Re: 60 Second Tube Feed Stop********

Originally Posted by Kymmi

You're telling me that stopping tube feeding for 60 seconds is some how going to prevent tube migration......and I'm sure you recheck tube position every time you reposition your pt.......the only accurate way to ensure tube position.........and the reason we 'break the habit' is because it is not an effective technique.....

It doesn't prevent tube migration, but it will prevent aspiration if the tube does migrate.

[Creamsoda]

Re: 60 Second Tube Feed Stop********

I have always thought it was stupid too, and only did it because everyone else did, and if I didnt they would always ask why didnt you hold the TF? I would try to explain my logic, but they would always say thats how we always do it.

Actually yesterday, finally our educator let us know that indeed we do NOT have to hold TF for quick repositioning, only if they will be supine for a while. Finally!

[Daytonite]

Originally Posted by Kymmi

Please explain to me why is it that nurses fail to use any common sense or stop to think about why they do the things they do.....for example, exactly what do you accomplish by stopping tube feeding; (whether DHT, Peg Tube, G-Tube, NGT) for 60 seconds while making a pt. supine in order to reposition them in bed, then sitting them back up to resume the Tube Feeding. With a Tube Feeding rate of 60cc/hr, that would prevent 1 cc from infusing......this will hardly prevent aspiration. The Tube Feeding should be stopped 1 hour in advance, then residual should be checked prior to putting a pt in supine postion......I'm sure that is what everyone is doing.......the old phrase 'well that's what everyone else does'.......just ain't good enough.......

What I would like explained is why another nurse would be upset about the practice of colleagues when it clearly isn't doing any harm to the patient and isn't in violation of a facility policy or a nursing standard of care!

[BBFRN]

Re: 60 Second Tube Feed Stop********

Legal Eagle Eye Newsletter for the Nursing Profession:
December 2006 Vol. 14 #12

Nasogastric Tube: Feeding
Continued While Position Still
Being Checked, Patient Dies.

"The patient was admitted to the hospital for respiratory problems. A
nasogastric tube was inserted to provide nourishment.
The tube became occluded after some period of use and had to be removed and replaced by the nursing staff. An x-ray was ordered to confirm correct placement. The x-ray showed it was not correctly
placed, that is, it extended down the trachea into the lung rather than down the esophagus into the stomach. The feeding tube was removed and replaced and another x-ray was taken. While reading of the second x-ray was still pending the nurses resumed infusing nourishment through the tube. In fact, the tube had again been inserted into the lung. Infusion of nourishment into the lung seriously compounded the patient’s respiratory problems and she
died. The Court of Appeals of Arkansas wrestled with legal technicalities involved in continuing the lawsuit against the hospital’s corporate parent after the hospital itself had settled with the family
for the consequences of the nurses’ negligence.
Lee v. Quorum Health Resources,
2006 WL 3222648 (Ark. App.,
November 8. 2006).
The allegations in the patient’s family’s lawsuit went beyond the negligence of the nurses.The lawsuit also found fault with the communication processes within the hospital between the medical and nursing staff. That would tend to indicate a more widespread problem
that a simple error or omission by the nursing staff.
COURT OF APPEALS OF ARKANSAS
November 8, 2006