peg tube without flush order

[supaflyz]

I have a question to ask regarding peg tube feeding. I'm usually good with peg tube and have experience quite a few patients that were on peg tube. One of the patient from another nurse two nights ago had an order for peg tube feeding without a flush order. I advised her to call the physician to clarify as I have always seen peg tube feeding with flush order. The physician told the nurse that the patient is eating and she doesn't need water flush. Patient is on peg tube feeding because of poor appetite. The nurse asked the charge nurse and the charge nurse called the physician again. The physician finally just said to give one bolus feeding can and he come take a look tomorrow. I won't be back until another two days. Don't we have to flush to prevent the peg tube from clogging?

[AJJKRN]

Do you not have a protocol that covers this? My facility covers all tubes (g/j, peg, Dobhoff, NG, etc).

[ProgressiveActivist, BSN, RN]

Yes. 30cc of water flush every six hours to maintain patency is standard in the hospital setting.

[MunoRN, RN]

Flushing for maintenance, not therapeutic purposes, does not typically require a physicians order and should be consider within the nurse's scope since you aren't administering water to treat a medical condition, you're using it to maintain a device under your care.

[LTC_LPN2]

I would say yes for both patency and hydration to prevent bigger issues like dehydration. If crush meds are being given through the tube it does require at least a 5cc to 10cc of water to administer all of the medication from the med cup...you'll end up with a clogged tube...I'm sure doc is assuming your judgment is to flush before and after meds and feedings...check facility policy for standing flush orders.

[LTC_LPN2]

Read your post wrong...let him unclog a tube after the feed has clogged it up nicely...depending how long she stays on those feeds or if she can hydratate PO...crazy how one orde can solve a bunch of chaos for docs lol

[MunoRN, RN]

The confusion is often that Docs assume you're asking about how much free water the patient should be getting, which would often fall under an MD order, they rightly assume that the nurse wouldn't be asking if they can flush the tube just for maintenance or med flushes.

[NOADLS]

"Sorry, you can't have lunch today because the doctor didn't order it."

"No. You aren't allowed to get out of bed today since the doctor didn't order for you to get out of bed."

[xoemmylouox, ASN, RN]

I would find our your facility's policy. If you need an order than clarify that with the MD. You may not need an order or you may already have standing orders fir these routine flushes that are part of standard care.

[supaflyz]

The next day the dietician fix the problem and reminded the doctor. Had order for water flush q4 h. Thank you for those who responded. NOADLS your smart comments are the reason for most altercations at work. I'm sure you know everything.

[KelRN215, BSN, RN]

It's standard of care. You don't need an order to flush a tube following a feeding or med administration or to maintain patency. A 30 mL flush doesn't require an order. Do you call the MD to order water to be given with meds for patients who swallow them?

[CoffeeRTC, BSN, RN]

Flushing with meds is normally covered in the policy/ protocol. I would contact dietary for the flush order if the MD is unable to order flushes.