help?! PEG tube incident

[morningloryRN]

Hey all,

Let me preface by saying i'm a brand new RN. Just graduated in May and i'm working on a medsurg floor. The other day i had a patient with a PEG tube who was receiving continuous feedings. I told the charge nurse i had never had a patient with a PEG tube before and they assured me not to worry about it and told me what they thought i needed to know about it. Long story short, i ended up giving a medication through the feeding tube that was supposed to be given PO. I assumed that because the pt had a PEG tube that their medications were to be given through this, HUGE MISTAKE, i know. Regardless, the pills clogged the PEG tube and the tube would not flush. i had 2 experienced nurses come in to look at the tube and try to unclog it, they could not. Finally, the charge nurse tried flushing the tube, during the flush the PEG tube fractured. You could visibly see where there was a crack in the tube (the part coming out of the abdomen). Needless to say i cannot sleep because of this. I feel absolutley horrible, the patient needs to get a new PEG tube now because of my carelessness. I'm scared of the repercussions of my actions and i just need some advice. An incident report was filed out by the nurse who fractured the PEG tube, but i still feel responsible. Please help!

[SuesquatchRN, BSN, RN]

I plugged a g-tube giving Prevacid one time.

Prevacid via tube is a bear. Those little teeny beads! GAH!

[chuchie, ADN, BSN, MSN, LPN, APRN, NP]

Prevacid via tube is a bear. Those little teeny beads! GAH!

I know! Those stupid pills clog the j-tubes all the time at my work. Also, when you crush the pills and soak them in warm water draw the solution up in a 10 ml syringe. If it goes up the 10 ml syringe ok then it probably won't clog the tube. If you have difficulty when drawing it up let it soak some more in the water and draw it up again.

[PostOpPrincess, BSN, RN]

If it makes you feel any better, replacing it won't be so bad. Ask the doc to put a lot of local and make sure you medicate the patient post replacement with some good pain meds.

It will be business as usual soon thereafter.

[Lacie, BSN, RN]

First of all, quit beating yourself up. Mistakes happen and you didn't kill anyone. PEG tubes have to be replaced periodically as they break down from use, meds, and stomach acid. Always check with your pharmacist about whether a medication can be crushed to be given per tube. Was the patient able to swallow the pills? If not then it was not appropriate for the physician to prescribe a med that could not be crushed and given per tube.

In order to keep something like this from happening in the future, remember that water is your friend when it comes to feeding tubes, whether they are PEGs, Js or nasal feeding tubes. Always flush with at least 30 ml of water before you give meds. Give each med separately, crushed and mixed in a little water, usually about 30 ml is enough. Flush with water between medications and before you resume tube feedings. If you are doing bolus feedings, check whether the medications need to be given before or between boluses, and always flush before and after each bolus. Most patients need anywhere from 500 to 1500 ml of water outside of their tube feeding product for hydration (if they cannot drink water or are not on IV fluids), so you should have plenty of water to use for medication administration. Just subtract the amount you've used for meds and give the rest as a flush.

There are commercial products that work well to unclog feeding tubes. The Clog Zapper is the one our team uses and we've had quite a bit of success with it, especially with J tubes and PEG tubes.

http://www.corpakmedsystems.com/Supplement_Material/Enteral Devices/ClogZapper/Clog Zapper Brochure.pdf

You can also crush a bicarb pill and a viokase pill, mix them together in warm water, and use that to try to unclog the tube. It's much cheaper than the Clog Zapper and utilizes inexpensive medications that are likely already in your hospital pharmacy (sodium bicarbonate and pancreatic enzymes). I don't think it works quite as well though.

Some people will tell you to use Coke. That is not a good idea, as the carbonic acid and sugar is hard on the tube and can cause it to fracture, especially over time if the tube becomes clogged often and Coke is used to unclog it.

BTW, welcome to nursing!!

Wow!! I remember when Docs used to order Coke to prevent clogging of NG tubes. Tells how old school I am haha!! Good advice!

[ellakate]

I have used this homemade method before with repeated success. Take a long, smaller bore tube. My choice is butterfly tubing, cut at an angle. Discard needle safely. Attach to 10 cc syringe full of warm water. Gently insert this into the middle of the clog and push as far as you can, then irrigate gently with the 10 cc syringe. By moving the tube around, I've been able to unclog tubes without harm to nurse, patient or tube. When the syringe is empty, pull the small tubing out and attempt to irrigate with traditional irrigation syringe. If not successful, return to the smaller syringe and long tube. Repeat the procedure.