PEG/J-tube comes out what do you do?

  1. 0
    At my facility we, historically, have gotten a foley cathater and put it in the residual opening (sterily), inflated the balloon, checked for gastric content return and plugged/clamped it. (Note: under no circumstances would anything be put into this tube until placement was verified by radiology.) The idea is/was that it would maintain the opening until another tube could be place by floroscopy without the patient having to under the whole procedure from top to bottom again.

    Recently there as been some debate on my unit as to the propriety of this historical practice. Our hospital doesn't have a policy/procedure to cover our butt etc. We may look into writing a policy etc. but I was wondering what other facilities/units do if a patient looses their tube.

    ~Jen
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  4. 10 Comments so far...

  5. 0
    when i worked in LTC, we would just put in another g tube. many facilities have them as a stock item, and nurses routinely replace them. we put them in, check for placement by listening for the rush of air, and we use them. in some facilites, (LTC) there is even a standing md order for the nurse to change the tube every 3 months.
  6. 0
    Quote from cursenurse
    when i worked in LTC, we would just put in another g tube. many facilities have them as a stock item, and nurses routinely replace them. we put them in, check for placement by listening for the rush of air, and we use them. in some facilites, (LTC) there is even a standing md order for the nurse to change the tube every 3 months.
    I should have specified. I am in an acute care setting. I know that it takes about 6 weeks to form a tract from the outside into the gastric space along the tube. If the tube comes out before this happens you risk reinserting into the peritonial space. If this tract has formed there is only one place the tube can go. My question was really for those patients who are in that 6 week window in which you risk quick closure of the hole and/or insertion into the peritonial space.
    ~Jen
  7. 0
    Quote from cursenurse
    when i worked in LTC, we would just put in another g tube. many facilities have them as a stock item, and nurses routinely replace them. we put them in, check for placement by listening for the rush of air, and we use them. in some facilites, (LTC) there is even a standing md order for the nurse to change the tube every 3 months.
    The original poster said a j-tube, not a g-tube. Big difference.
  8. 0
    We've always done the foley thing, too. I'm in the NICU, and every baby that had a G-tube would have one of those red rubber caths in a sterile pack at the bedside, and if the tube came out we'd just put that in until surgery could come and replace the tube. The only tubes we were allowed to replace ourselves were Mic-Keys, which they don't put in our babies for at least two months after initial G-tube placement (feeling is that by that time the stoma is pretty healed). We even give those caths to the parents to take home if the baby is discharged, so that if it comes out and they can't get the Mic-Key in, they can at least keep the hole open until the surgeon can replace it.

    If it's a G-J tube, we'll just concentrate on keeping the hole open with a Mic-Key or catheter until surgery can replace the J-tube portion and confirm everything by x-ray studies.
  9. 0
    what about suturing the PEG tube? That's why I can't see nursing staff routinely replacing it. Of course they can put a foley or something until surgery or someone can replace it...
  10. 0
    Quote from zacarias
    what about suturing the PEG tube? That's why I can't see nursing staff routinely replacing it. Of course they can put a foley or something until surgery or someone can replace it...
    Sometimes they are sutured during surgery to keep them in place during the first few weeks of healing. However, the sutures would have to be in the top layers of skin, and your skin regenerates over time, so eventually the sutures would come out of the skin. Plus, it's got to pinch quite a bit and there is no need to cause unnecessary pain. It's not like tubes are coming out all over the place - usually the balloon works just fine.
  11. 0
    Quote from zacarias
    what about suturing the PEG tube? That's why I can't see nursing staff routinely replacing it. Of course they can put a foley or something until surgery or someone can replace it...
    G-tubes can actually be easily replaced. They are done in the home by parents all of the time. It isn't any difference than placing a Red Robinson or a foley there until the doctor comes in. Just depends on what your facility's policy is.
  12. 0
    We had a resident that loved to pull his out.
    The LPNs were allowed to insert a foley, we didn't even inflate the bulb, we taped it to the abdomen, and called the RN on call. She immediately came out and replaced it with a new button.
    We had to come up with something to help protect the button because he loved to pull it out so much. They bought him some tight fitting body suits and he would have to wear those when he got on this "pulling out my button spree." This resident is mute, but he could understand everything said to him. Over time we got to understand that he was trying to tell us something was wrong when he pulled his button out. He was usually ill, didn't feel good, or was getting sick with pneumonia. I think he was doing it get attention to the fact that he was not feeling good.
  13. 0
    The original poster wrote PEG/J tube with her question. These are two very different tubes, one is in the stomach and can easily be replaced at the bedside.

    A Jejuostomy tube is never replaced at the bedside. It requires a surgical procedure, in most cases. It required a surgical procedure to be placed, it cannot be placed in a GI lab. The tube is threaded into an opening in the jejunum. That is why most of these are sutured in place, but not the G-tube.


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