[earle58]

[quote=Night Angel]

Originally Posted by mwrn

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.

that's why i find it so scary that uap's would be able to do so. it DOES require skill/judgement.

[LPNer]

In other states and in this state in home care, it is acceptable for nurses (RNs and LPNs) to insert a new Gtube when needed. That is both regular g-tubes and buttons.

However, at my current hospital, nurses are not allowed to replace a g-tube. We have to call the house doc, felt bad waking him up for something I went from house to house once a month to do for a long time. OH well. That's nursing.

[jennifersusan]

We recently had a patient who was in our ICU on the vent, CRRT for almost a week, with major complications after an MD reinserted his G-Tube which had become dislodged in the long term care facility he was at. The GT was misplaced, and he got over 24 hours of tube feeding into his abdominal cavity (but not stomach) before becoming septic. They believe that he was actually throwing micro-clots of tube feeding all over his body, he had necrotic areas on his forehead, knees, feet, and lost both of his hands. After about 2 1/2 weeks of his being in the ICU, on CRRT, regular runs of hemo-dialysis, continual CV and PV problems resulting from his sepsis, the family decided to withdraw cares.

I have never heard of an MD giving an order to re-insert a GT, (as someone else said - we don't see that very often in the ICU), but I would caution that whoever does this be extremely careful and make certain to confirm placement, and that as an RN taking care of the patient, you always check placement when giving feedings or meds.

[LPNer]

Originally Posted by jennifersusan

We recently had a patient who was in our ICU on the vent, CRRT for almost a week, with major complications after an MD reinserted his G-Tube which had become dislodged in the long term care facility he was at. The GT was misplaced, and he got over 24 hours of tube feeding into his abdominal cavity (but not stomach) before becoming septic. They believe that he was actually throwing micro-clots of tube feeding all over his body, he had necrotic areas on his forehead, knees, feet, and lost both of his hands. After about 2 1/2 weeks of his being in the ICU, on CRRT, regular runs of hemo-dialysis, continual CV and PV problems resulting from his sepsis, the family decided to withdraw cares.

I have never heard of an MD giving an order to re-insert a GT, (as someone else said - we don't see that very often in the ICU), but I would caution that whoever does this be extremely careful and make certain to confirm placement, and that as an RN taking care of the patient, you always check placement when giving feedings or meds.

That was not the fault of nurses, in general, replacing g-tubes. That was the fault of 2 or 3 nurses who didn't bother to check placement in a 24 hour period! Even with a continuous TF running, you check tube placement Q4hours, that is reasonable and prudent nursing practice . If it was not done, it's not the fact that a nurse missed the stomach, it IS a fact that s/he and co-workers did not check the placement before running the feeding and intermittantly while the feeding was running.

[Gompers]

I work in the NICU, but we do see a fair amount of G-tubes. I was always taught to place a "red rubber catheter" in the stoma if the G-tube comes out, and then to call a surgeon to have the feeding tube replaced. I honestly have no idea if it's a foley or not, because we don't use regular foleys. Ours are 5 or 8 french, so neither is big enough to stent a G-tube site open and we order the larger red ones just for this purpose. We also send some home with the parents and tell them to do the same thing - insert the catheter, call the surgeon, and/or take the baby to the ER for reinsertion.

[braininjryRN]

[quote=earle58]

Originally Posted by Night Angel

Actually,with the new G-tubes it doesn't. They don't migrate. All that has to be done is to pop one in,instill the water into the ballon. Then check for placement with an air bolus and go. Nothing to it. What part of that requires skill or judgement. Now the skill or judgement is required if there is a problem with the insertion or the tube once its inserted. After my staff inserts one, I always go double check them. So far, no problems.


that's why i find it so scary that uap's would be able to do so. it DOES require skill/judgement.

[dbsn00]

On my unit we have a couple of residents that have MD orders to reinsert if pulled out or dislodged, otherwise we insert a foley & send them to the hospital. We have a couple of residents who really like to play with their tube so we use abdominal binders as a preventative measure which seems to be working well, last time I had to reinsert a GT was at least 3 months ago.

[LPNer]

Originally Posted by dbsn00

On my unit we have a couple of residents that have MD orders to reinsert if pulled out or dislodged, otherwise we insert a foley & send them to the hospital. We have a couple of residents who really like to play with their tube so we use abdominal binders as a preventative measure which seems to be working well, last time I had to reinsert a GT was at least 3 months ago.

Our med/surg units use abd binders for htis purpose also. Last time I ran into it up there I found putting the abd binder on backwards provided even more security after I walked in and found she liked playing with the binder as much as playing with the g-tube. (works with baby diapers too, I have put many a diaper on my grandbabies backwards to keep them from being un-velcroed and tossed aside.)

[pediatriclpn]

I have worked many LTC's where every gtube, was a foley, so if it came out we (LPN's and RN's ) changed them. Working in homecare, esp. with the kids they mainly these days have mic-keys, not much to changing them, we change them every month, and teach the parents to do it if something should happen when nursing isn't around. I always check for placement, etc., etc., etc. There are lots of things that happen in home care that never would happen in the hospital. Parents are taught to do TPN's change dressings on central lines, change trachs, run ventilators, etc. etc. etc. I do have a problem with untrained personnel given more and more responsibility in higher acuity settings just so that the facility can save a buck or two, but in home care where insurance will only pay for maybe 8 hours of care of day for a vent dependent child, and the family has to do the other 16 by themselves, there isn't much else to do.

[Danish]

Originally Posted by Speculating

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

I believe it to be beyond the Scope of Practice for LPN's and lower. It's pushing the profession of RN to place a new G-tube.[/quote]

Im an LPN student and at clinicals last week we had PEG tube pulled out. We called the physician and he came in to reinsert it. The nurse was told to NOT touch it. (She was an LPN)