G Tube Placement or Not...

Specialties Med-Surg

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Specializes in Hospice.

I'm a very new nurse and I have a pt who has a g tube, is non-verbal has a trach and is diabetic. Now his feeding last night was running. I checked for placement of the tube by instilling 20-30 ml of air and put my scope over his lower left epigastric area I heard the swooshing I'm never able to aspirate anything so I wasn't surprised to not have anything come back. But when I was giving him his 325 ml of water his tube popped out to the #8 FR mark. I was concerned and listened for placement again and heard it. I had a co-worker come down to confirm and so I started his feed again.

At 3AM I went in to give him his water and this time during the admin his g tube came out to the #6 mark which is farther than I have ever seen it come out. I couldn't push it back in, every time I tried to pop it back in it would slide back out. I couldn't hear placement, and every time I tried to pull all of the air out of his stomach I was never meeting resistance like I had gotten it all. Also when I was flushing it with the water it was draining faster than whats usual for him. Are these all signs that it wasn't in the stomach? What do you think happened?

I called the doc to hold the feed because I wasn't comfortable running it without a + placement, but I feel like I could have done things differently.

Anyone have any experience with stuff like this.

God Bless.

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Specializes in Acute Rehab, IMCU, ED, med-surg.

I believe G-tube placement is checked radiographically post-placement, and not by instilling air. Rather, checking residual before each feeding, or at specified intervals if feedings are continuous, is the norm. Residual greater than 200 mL would indicate feeding should be held. I haven't ever instilled air into a PEG tube. Of course, if in doubt, follow your facility policy, but sometimes, they are confusing, or only written to address NG tubes.

It is very frustrating to find policies and research to guide us in taking care of patients with G- and J-tubes, because there is much inconsistency. I found an article last spring that is my go-to for understanding these devices. Their management is very different from NG tubes, for sure.

The article is in the March-April 2013 issue of Med-Surg Nursing, and is called "The Percutaneous Endoscopic Gastrostomy Tube: A Nurse's Guide to PEG Tubes," by Simons and Remington. It is the best one I've been able to find on this topic.

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Specializes in Hospital Education Coordinator.

when something does not seem right about placement, an x-ray is in order. Phone MD.

Aside from that, are you checking blood sugar regularly? We have a protocol for diabetics getting continuous or intermittent tube feedings. The formulas are concentrated and have a lot of sugar. Additional insulin may be required and more frequent monitoring is the standard. Good luck with this challenging patient!

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All of my patients have GTubes/Peg tubes and we do instill air and check residual before each flush - I would have contacted the Dr as well and held the feed!

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Specializes in Critical Care.

I don't really get the rationale for instilling air to check for placement with a G tube. If the the tip has somehow come out of the stomach but has not come completely out then the tip would be in the peritoneal cavity and would make the same sound in the same area is if it was in the stomach, so what purpose does it serve?

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