Tube feeders-vomiting,diarrhea,aspiration

  1. I work in LTC and it seems like our G-tube feeders are frequently congested, having diarrhea and having vomiting episodes. We report these things to the doctors but they don't do anything about it except order antibiotics. How is it at your facility? What should we do to stop the vomiting, diarrhea and aspiration episodes? Thanks
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  2. 18 Comments

  3. by   nursedawn67
    Quote from Blackcat99
    I work in LTC and it seems like our G-tube feeders are frequently congested, having diarrhea and having vomiting episodes. We report these things to the doctors but they don't do anything about it except order antibiotics. How is it at your facility? What should we do to stop the vomiting, diarrhea and aspiration episodes? Thanks

    I guess I would first be sure everyone is doing the obvious...head up, checking for tube placement and residual, and is the rate and amount of feeding too much for that resident. After that maybe check to see if they have an intolerance to that particular formula, are they also taking oral intake, if so maybe they are getting too much in during the entire day ( I have a resident that I have seen this as the case).
  4. by   CoffeeRTC
    Biggest thing to watch...HOB up. When CNAs are doing care are they turning off the pump or putting it on hold? Checking placement even with g tubes. Getting them OOB everyday to sit up in chairs. As far as N/V/D..might need a formula change..something with more fiber. We use a lot of fibersource HN, or Diabatic Resourse. Maybe look into down times and flushes. If they are getting Po intake...maybe speech needs to re evaluate swallowing.
  5. by   Blackcat99
    Thanks so much for your very helpful information. I was told that you only need to check placement with NG tubes not GT Tubes. How exactly does one check for GT placement and residual?
  6. by   CoffeeRTC
    Most G tubes stay in place. Still will check with air, esp if they are frequent transfers or if the tube isn't used much. As far as residual we only do this on new tubes. Just pull back on the syringe and note amt of any. Then re insert.
    With NG tubes (rarely see these any more since most will come with the Gtube) I am hyper vigilant with checking placement.
  7. by   redshiloh
    Check residuals. If they are over 1.5 times the infusion rate, feedings should be held for an hour and rechecked, then if the residual decreases, restart. It is possible in the elderly to have ileus, gastroparesis that can lead to regurge,vomiting which can also lead to aspiration.
  8. by   Blackcat99
    Thanks again . I just made out my health directive and it specifically says "No tube feedings. I just feel so sorry for the lady who is always nauseated and always having diarrhea. It's so true when they say there is a fate worse than death.
  9. by   NRSKarenRN
    google helped compile this info:

    check gastric residual before each gt feeding or as ordered for continuous feedings. hold feeding prn for high residuals (> 1/4 of feeding amount) or as ordered.
    http://home.texoma.net/~sferrer/careplan5.htm


    patient ed + pictures
    http://patienteducation.upmc.com/pdf/gastrotubefeed.pdf


    gastrostomy tube (g-tube) home care
    http://www.cincinnatichildrens.org/h...-tube-care.htm






    flow diagram:




    management of a child whose gastrostomy tube or button has been dislodged http://www.starship.org.nz/docs/gastrostomy.pdf




    tube feeding in the elderly
    the technique, complications, and outcome
    http://www.postgradmed.com/issues/20...harmarajan.htm




    mechanical complications in long-term feeding tubes




    Last edit by NRSKarenRN on Dec 24, '04
  10. by   Blackcat99
    Thanks so much NRSKarenRN. I found all of those sites you listed to have such great information! :hatparty:
  11. by   TracyB,RN
    Awesome sight referrals NRSKaren....
    I wanted to ditto the obvious, such as HOB ^, feeding on hold, while pt being turned for cares..... ALWAYS check residual...If patient has a peg tube, they are usually in place, but I still like to check placement by listening at sight with 5-10 cc air bolus, then I let the tube vent (like burping it).
    At a previous facility, when our feedings changed, the pts often would end up with N/V/D... probably needs a new formula, along with the basics of GT feeds, head up!!!!!!
  12. by   mitchsmom
    you may have already considered these... is the formula at the right temp, not too cold? It may also be lessened with diluted feedings, a different product, or slower infusion?
  13. by   sis14rn
    Are your tube feeders dumping? I think you need to get your dietitian involved, maybe it's the feeding. How are the nurses giving meds via the tube? Is it drug interaction? Are you keeping the HOB up? Putting them on ABX could be increasing your vomiting and diarrhea. Hope this helps
  14. by   Blackcat99
    Thanks all for your great suggestions! :hatparty: She is on Jevity Plus 75 cc an hour. Other nurses have faxed her doctor to see if something different can be tried.So far no response from her doctor. I have heard that this doctor will agree to most of the nurses suggestions. If you were her doctor what feeding would you suggest and at what rate? Thanks

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