[braininjryRN]

Originally Posted by earle58

QUOTE=safc1111]

Where I work which is an assisted living facility I train the staff who are not licensed to re-insert G-tubes. I teach them just like I was taught including checking for placement post insertion and pre- medication administration or feeding. [

i respectfully disagree with unlicensed staff inserting g-tubes.
it is definitely a skilled procedure and should not be delegated to nsg. assts. or anyone that's not licensed.

leslie[/quote]

according to the standard in my state, an unlicensed person who is taught and checked off as competent can perform any routine task that does not require nursing judgement. This includes G-tube insertions. They are taught by RN's and attend comptency classes quarterly. The nursing shortage has changed a lot of the things that only nurses have done in the past. Just like medication administration, anyone who is taught and checked off by an RN can give meds.

[Tweety]

Unlicensed staff here insert foley's so it's not a stretch for them to reinsert a dislodged g-tube. However, that isn't something I would choose to delegate, I would do it myself and have on several occasions. It's not one of those tasks on the techs check off lists.

We have a radiology test, "g-tube insertion" or something like that, that we can order after we reinsert a tube. They inject gastrograffin or something like that to check for patency and leakage, afterwhich we can restart the tube feeding. An MD need not be involved, except to give the order to re-insert and for the xray.

I only pre-sume this is o.k. with the nurse practice act. Silly me.

[earle58]

Originally Posted by braininjryRN

according to the standard in my state, an unlicensed person who is taught and checked off as competent can perform any routine task that does not require nursing judgement. This includes G-tube insertions. They are taught by RN's and attend comptency classes quarterly. The nursing shortage has changed a lot of the things that only nurses have done in the past. Just like medication administration, anyone who is taught and checked off by an RN can give meds.

hmmmmm.
inserting g-tubes is not a routine task and it does require ngs. judgement.
i still maintain that only licensed nurses insert g tubes and foleys. there are too many risks if not done adequately.

leslie

[NancyJo]

When I worked on a NHCU @ a VA, I was trained to reinsert g-tubes that had been pulled out or became occluded. At that time it was actually one of the skills that would be listed on my evaluation. Many of the g-tubes at that time had been long term and were foleys, so that was what I reinserted. I however was speaking with some my current coworkers, who most have never worked anything other than acute care and they were shocked.

[Blackcat99]

At the LTC we sent our residents to the ER to have G-tubes replaced.

[tiredfeetED]

Dont use a stylet like i seen a ED doc do..the patient may comeback with bowel all in the wrong place!

[earle58]

when one of my pts had dislodged a g tube and we didn't have any gtubes in the house, i would put a foley in only until the gtubes arrives. (our adon didn't believe in us having much of an overhead)- some people don't realize how fast a stoma can close up, matter of 2-3 hours.
but yes, i have seen those that have come to us with foleys as their fdg tube....and they never last long.

[earle58]

Originally Posted by NancyJo

When I worked on a NHCU @ a VA, I was trained to reinsert g-tubes that had been pulled out or became occluded. At that time it was actually one of the skills that would be listed on my evaluation. Many of the g-tubes at that time had been long term and were foleys, so that was what I reinserted. I however was speaking with some my current coworkers, who most have never worked anything other than acute care and they were shocked.

shocked at what? that unlicensed assistants were inserting these?

[mwrn]

[quote=safc1111]Looking for anyone who knows about reinserting g-tubes after they become dislodged or pulled out.Can Rn/LPN's reinsert them and are you aware of a policy for it? Is it legal? How is it done? We had a MD tell a nurse to reinsert one until he could get in ,in the morning.Tube feeding was NOT to be restarted .but he wanted the tube in so it would not close up.....Would like to get some opinions on the subject.What is done in nursing home and /or rehab centers for the mentally challenged?? Got any ideas or answers.....AND Hi ,I am an ICU/CCU nurse...we only have a few with g-tubes and have never encountered this before...Thanks[/QUOT

what we do at my facility is use a foley cath (inserted) until one can be replaced by the gastro man! Do not feed through the foley cath, use only as a emergency basis for keeping the track open.

[Night Angel]

[quote=mwrn]

Originally Posted by safc1111

Looking for anyone who knows about reinserting g-tubes after they become dislodged or pulled out.Can Rn/LPN's reinsert them and are you aware of a policy for it? Is it legal? How is it done? We had a MD tell a nurse to reinsert one until he could get in ,in the morning.Tube feeding was NOT to be restarted .but he wanted the tube in so it would not close up.....Would like to get some opinions on the subject.What is done in nursing home and /or rehab centers for the mentally challenged?? Got any ideas or answers.....AND Hi ,I am an ICU/CCU nurse...we only have a few with g-tubes and have never encountered this before...Thanks[/QUOT

what we do at my facility is use a foley cath (inserted) until one can be replaced by the gastro man! Do not feed through the foley cath, use only as a emergency basis for keeping the track open.

I've inserted g-tubes or foley catheters as g-tubes in LTC facilities, checked for placement via air and auscultation and never had a problem. But on the other hand, I've worked at an LTC facility where it was forbidden for any nurse to insert one. Instead, the pt was immediately sent to the E.R. for replacement and an x-ray to make sure that it was in place. The administrator of this particular facility said that she had seen too many instances where g-tubes or foley catheters used as g-tubes were misplaced causing the stomach to rupture, and she was not taking any chances in her facility. I work in a hospital now, so we have the G.I. lab to take care of g-tube insertion now.