I know you're supposed to check for G tube placement by checking residuals and instilling air and listening to a gurgling sound with stethoscope. I'm just wondering. If...let's just say the Gtube went into the peritoneal cavity instead...would you hear a gurgling sound too when you instill air? The scenario is you checked residuals and there was none.
Also...is it common for the area around the stoma to be red after a pt pulls out his g tube? I understand that stomach contents can irritate the skin, but am I possibly looking at an infection here?
Also...the lvn told me he can't re-insert gtubes so he asked me for help, and i did. But I thought lvns can re-insert gtubes ( i mean i even see mommies replace mic-key buttons on youtube)...
Dec 22, '08
the only ways to check a gtube for place ment are radiologically or by pH....the instilling air is useless, for the very reason you noted.....if it migrates into the intestine you will hear it ...moms can do things for their children that nurses are not nec allowed to do......good luck
Dec 22, '08
I think you are confusing NG tube placement check with G-tubes.
G-tubes are surgically places and usually don't migrate so you don't have to worry about checking for placement.
yes - a stoma can be red after a pt pulls out a g-tube. It could be infected - not seeing it personally I can't access that. If in doubt, have an MD assess.
Can't answer your LVN question.
Dec 22, '08
I ama student PN we are taught to insert the tubes as well as to take them Out NG tubes that is but as far as doing it every NCLEX queston that I have seen or had it states the LPN helping the RN with the insertion and removal of the tube. But like the othe posts I think you are talking about a G-tube. We learned how to change the dressing and to clean those and to check for placement but that is all I can remember we were taught.
Dec 22, '08
You are supposed to check placement and residual as you mentioned before instilling anything into the tube. It's a far from fool-proof verification. Mostly good for determining residual. But we have to do it any way. Tubes can and do migrate or perforate. If they perforate, you are going to be looking at classic "surgical abdomen" symptoms. They also can also obtruct (partially or fully) the pyloric sphincter. With that you see large residuals and vomiting.
After re-insertion, the stoma is often red, irritated, possibly swollen, especially if the tube was accidentally pulled with the ballon intact or there was much leakage of gastric contents. The stoma and peri-stomal area can get infected. Fungal infections are very common, but bacterial infections do occur. If the area is very red but not infected, something like Bacitracin ointment may be ordered to protect and hopefully prevent infection. The usual antifungal creams can be ordered and for bacterial infection, Bactroban is usually ordered. Systemic antibiotics are rarely necessary. Cultures are rarely ordered. Assess and follow facility procedure as you would for other topical infections.
As far as I know re-insertion of G-Tubes after the site has healed is within the scope of practice for LPN/LVN's in all states. Many facilities have policies against it. Some LPN's weren't trained in school to do it. It's best to do as you did and do any procedure yourself that the LPN/LVN doesn't feel competent to do.
We are both referring here to the commonly used "Foley-type" tube which is not surgically inserted. J-Tubes and most PEG tubes must be re-inserted by the interventional radiologist. Mic-Key buttons may be connected to a GT or a JT. If connected to a GT the parent may change it (or an LPN/LVN). If connected to a JT, it is also re-inserted by the interventional radiologist.
Many things on the NCLEX-PN state "helping the RN' because post-graduation training or certification is required in some states to perform the procedure independently. A prime example is insertion of peripheral IV's. It is within the scope of practice in most states for LPN's to do this. However, the training requirements vary from employer sponsored training to an additional state certification/license. The NCLEX-PN is based upon the skill set that expected of a new grad throughout most of the country. A PN student may check with an instructor as to whether GT re-insertion is a generally required skill where you are.
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