G-Tube Feedings and loose stools

Specialties Geriatric

Published

Hi

I have a pt who is on G-tube feedings who has loose stools. When she has a bm and we clean her up, she bleeds from the orifice. She does NOT have bloody stool, it is coming from the outside.

I reported it to the head nurse and she said she is giving her Metamucil to firm up the stools. I tried to tell her that we NEED to give her something to BLOCK and protect the area. She became defensive and said she was doing the best she could. This pt is in extreme pain and screams when we clean her up!!

PLEASE advise!!

Thanks!

____________________________

In His Grace,

Karen

Failure is NOT an option!!

Will someone please explain how metamucil helps with rectal bleeding? Even a formed stool isn't going to stop the pain of cleansing her.

Thanks!!

______________________________

In His Grace,

Karen

Failure is NOT an option!!

i think posters are saying that your pts' loose stool is the major factor in the excoriated areas.

so, if the loose stool is the culprit, then having formed bms would prevent further skin breakdown....thus, the metamucil.

i agree she needs something for her skin, and stat.

but i think she needs a consult from the rd, to find out why she's having loose stool, and to possibly change the formula (probably one w/fiber) or to have continuous fdg.

all the barrier cream in the world isn't going to help if your pt has a fungal infection.

also, barrier creams aren't meant to be scrubbed off; another factor that contributes to unnecessary bleeding and pain.

i think right now your pt needs a couple of consults.

one for a formula/schedule change and the other for eval and rx of excoriation.

leslie

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Just a bit off subject, but Baza Anti-Fungal does seem to work wonders. Critic Aide is something you should NOT scrub off, either.

Back to the posting, folks!

Suebird :p

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Specializes in Utilization Management.
Just a bit off subject, but Baza Anti-Fungal does seem to work wonders. Critic Aide is something you should NOT scrub off, either.

Back to the posting, folks!

Suebird :p

Baza's nice, but they also make a Triple Care antifungal barrier cream that's much more effective for people with loose stool. We use it for C diff patients because it stays on well.

Here's a link:

http://www.a-zmedical.com/skincare.html

But of course, if the stool is loose enough, you might ask the doc to prescribe a Flexi-seal fecal bag in addition to a good skin barrier/antifungal. We've recently been using them for some of our C diff patients and man! they're just the ticket!

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She isn't on continous feeding just boluses Q4H. She gets Diabetasource 250 ml + 250 h2o flushes. The bleeding isn't from hemrrhoids. The actual anal creases are bleeding.

Will someone please explain how metamucil helps with rectal bleeding? Even a formed stool isn't going to stop the pain of cleansing her.

Thanks!!

______________________________

In His Grace,

Karen

Failure is NOT an option!!

wow a 250cc water flush?? I hope that's not a single amount at once!

Are you monitoring her electrolytes, especially sodium levels? Have you asked for a GI consult? Has she been checked for things like Crohns, Colitis, IBS?( for the loose stool)

I am just trying to brainstorm from what I have experienced & have been taught........the bleeding may be just irritation from loose stools

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Specializes in Orthosurgery, Rehab, Homecare.
She isn't on continous feeding just boluses Q4H. She gets Diabetasource 250 ml + 250 h2o flushes. The bleeding isn't from hemrrhoids. The actual anal creases are bleeding.

Will someone please explain how metamucil helps with rectal bleeding? Even a formed stool isn't going to stop the pain of cleansing her.

Thanks!!

______________________________

In His Grace,

Karen

Failure is NOT an option!!

The metamucil will not directly heal the fissures, but it will firm the stool(it's a bulk forming laxative- absorbs water.) (Be sure to mix it with plenty of h20 when you put it in the tube)The metamucil will firm up the stool and make clean up easier on the bottom and the body can then heal itself. Sometimes, like others said, dietary can recommend a formula change, usually switching to one with fiber that may help. Also, a benzocaine or lidocane spray or gel may help if applied before clean-up. Also, witchhazel pads, like for hemorhoids can help.

~Jen

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Specializes in Gerontology, Med surg, Home Health.

When Metamucil fails, try Questran...seems to work better. And did I misunderstand but did someone say "wash out the feeding bags"?? Don't all y'all use disposables?

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Specializes in Alzheimer's, Geriatrics.

Most nursing homes do use disposable bags, but I think she was refering to her daughter when she said that and, most at home tube feeders use a reusable bag to help cut down on costs.

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Specializes in ER, OPEN HEART RECOVERY.

Patients on tube feed always have diarrhea. Thats how they get back at you. If I were you I would call, V.O. whatever you need to do to get a rectal tube. Insert tube and the problem is solved. Patient's butt heals, Laundry service sends your floor a thank you note, and you get to go on with saving lives.

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Specializes in Geriatrics, Pediatrics, Home Health.
Patients on tube feed always have diarrhea. Thats how they get back at you. If I were you I would call, V.O. whatever you need to do to get a rectal tube. Insert tube and the problem is solved. Patient's butt heals, Laundry service sends your floor a thank you note, and you get to go on with saving lives.

Give me more info please.

I thought the rectal tube was used to remove excess gas not to contain diarrhea.

Also, how would one use a rectal cath. w/o causing further harm?

Since she is diabetic can they switch her formula?

Her G-Tube is fairly new. we were feding her through an NG tube.

Thanks!!

_____________________

In His Grace,

Karen

Failure is NOT an option!!

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Specializes in Utilization Management.
Give me more info please.

I thought the rectal tube was used to remove excess gas not to contain diarrhea.

Also, how would one use a rectal cath. w/o causing further harm?

Since she is diabetic can they switch her formula?

Her G-Tube is fairly new. we were feding her through an NG tube.

Thanks!!

_____________________

In His Grace,

Karen

Failure is NOT an option!!

Yes, there's a new rectal bag that contains diarrhea, called the Flexi-Seal.

Convatec makes it. You need a doctor's order. The tube is inserted into the rectal vault and is held in place by a soft inflatable ring. Loose stool flows down the tube and into a bag at the end of the tube. When the bag is full, you just pop the bag off and put a new bag on; you don't have to replace the entire tube.

The tube can be irrigated, it can stay in place for days. (I don't recall how many.)

We've had no problems using them and it really gives excoriated skin a chance to heal. Even alert, oriented X3 patients consider them a blessing because this way they don't soil themselves when dealing with problems like chronic diarrhea or C. Diff.

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