Is this a big deal?

[guest769224]

So, I want to better understand this and need some clarification from the members here.

A few days ago, I was halfway through bathing my patient with another more experienced nurse assisting me.

We washed the front side of his body and I was lowering the HOB so I could have him turn to his side.

As I was bringing it down, the other nurse said, "Wait!! Aren't you going to pause your feeds?"

I said to her, "I thought that was only if the feeding tube was in the stomach?" My patient had the SBFT placed in his duodenum, cleared by imaging and doc.

She said, "No, you always always always pause your feeds no matter what when you put the HOB down. The patient could aspirate!"

I was a little tempted to challenge her back, but decided it was best to follow her advice and I paused them. So that leads to my question...

I worked as an ICU tech for 3 years and saw nurses put the HOB down without pausing feeds hundreds of times! I have been told it's not necessary, and that the likelihood of reflux and aspiration is very low. In fact, in my 4 years healthcare exp., I have never heard of it occurring. The feeding product would have to bypass the pyloric sphincter, and esophageal sphincter both, and then up the esophagus in order to even risk aspirating.

That just seems very unlikely to happen in my opinion. Then again I am a new nurse and could be wrong.

Can someone please clear this up for me? What do you personally do?

For the record, I don't plan on pausing my feeds for repositioning in the future, unless indicated for safety.

[TheCommuter, BSN, RN]

If the enteral feeding is being pumped into the small intestine (e.g. duodenum, jejunem), the likelihood of the formula reaching the lungs is trivial. I think your train of thought is correct.

[NickiLaughs, ADN, BSN, RN]

I agree with commuter. This could be a lesson she learned from when she initially started nursing and I imagine feeding tubes were not placed in the small intestine previously.

its sorta like trying to get everyone out of the habit of checking the foley balloons prior to insertion. New best practice recommends we don't.....but 90% of the nurses I assist still do it. It's hard to change previous practice when it's sort of automatic in your head.

[missmollie, ADN, BSN, RN]

As long as the tube is post-pyloric you're fine. But what happens when you don't pause a tube feeding because they have what should be post-pyloric, but it's actually just curled in the stomach? Then the patient by some miracle does aspirate. You go to court, where they have a nurse expert who testifies that a prudent nurse would've paused the tube feeding...

I just pause the tube feed. Takes all of two seconds to do.

[sandytoes]

As long as the tube is post-pyloric you're fine. But what happens when you don't pause a tube feeding because they have what should be post-pyloric, but it's actually just curled in the stomach? Then the patient by some miracle does aspirate. You go to court, where they have a nurse expert who testifies that a prudent nurse would've paused the tube feeding...

I just pause the tube feed. Takes all of two seconds to do.

I'm a new nurse so I recognize that I'm overly cautious, but I do it for the same reason. That and I feel like it's never a bad habit to get into. That way no matter where the tube is for the patient, I pause the feed out of habit. Rather over pause than forget once and have a problem, I figure....

[MunoRN, RN]

Tube feedings should not be paused when repositioning, regardless of where the tube is, there is absolutely no benefit to this but it does often result in long periods of missed feedings when staff forget to restart the feeding which not only impairs nutrition but has been known to cause more acute problems such as hypoglycemic episodes.

Common gastric volumes can be as much as 500ml, and is often 200ml or more. If you stop a tube feeding running at 60ml/hr to avoid adding more tube feeding the stomach while the patient is flat, how much are you actually avoiding? If the patient is flat for 2 minutes then you've only kept 2mls from getting into the stomach (and that assumes there is no gastric emptying while flat which is unlikely). There seems to be some sort of belief that by pausing the feeding the stomach magically becomes empty, when it essentially has the same volume, and therefore the same risk for aspiration, whether you pause it or not.

[Been there,done that, ASN, RN]

It was your patient.. do what you want.

[morte, LPN, LVN]

Tube feedings should not be paused when repositioning, regardless of where the tube is, there is absolutely no benefit to this but it does often result in long periods of missed feedings when staff forget to restart the feeding which not only impairs nutrition but has been known to cause more acute problems such as hypoglycemic episodes.

Common gastric volumes can be as much as 500ml, and is often 200ml or more. If you stop a tube feeding running at 60ml/hr to avoid adding more tube feeding the stomach while the patient is flat, how much are you actually avoiding? If the patient is flat for 2 minutes then you've only kept 2mls from getting into the stomach (and that assumes there is no gastric emptying while flat which is unlikely). There seems to be some sort of belief that by pausing the feeding the stomach magically becomes empty, when it essentially has the same volume, and therefore the same risk for aspiration, whether you pause it or not.

there is no point in pausing the feeding, unless the patient has known incompetence of the cardiac sphincter, and then you would need to do it for at least one half hour, BEFORE putting patient flat. and yes, had a case of dropped BS last noc at work because someone who should not have touched the pump did, and did not put it back on!