dislodged G-tubes

leslie :-D · Mar 16, 2005

according to the standard in my state, an unlicensed person who is taught and checked off as competent can perform any routine task that does not require nursing judgement. This includes G-tube insertions. They are taught by RN's and attend comptency classes quarterly. The nursing shortage has changed a lot of the things that only nurses have done in the past. Just like medication administration, anyone who is taught and checked off by an RN can give meds.

hmmmmm.

inserting g-tubes is not a routine task and it does require ngs. judgement.

i still maintain that only licensed nurses insert g tubes and foleys. there are too many risks if not done adequately.

leslie

NancyJo · Mar 17, 2005

When I worked on a NHCU @ a VA, I was trained to reinsert g-tubes that had been pulled out or became occluded. At that time it was actually one of the skills that would be listed on my evaluation. Many of the g-tubes at that time had been long term and were foleys, so that was what I reinserted. I however was speaking with some my current coworkers, who most have never worked anything other than acute care and they were shocked.

Blackcat99 · Mar 17, 2005

At the LTC we sent our residents to the ER to have G-tubes replaced.

tiredfeetED · Mar 17, 2005

Dont use a stylet like i seen a ED doc do..the patient may comeback with bowel all in the wrong place!

leslie :-D · Mar 17, 2005

when one of my pts had dislodged a g tube and we didn't have any gtubes in the house, i would put a foley in only until the gtubes arrives. (our adon didn't believe in us having much of an overhead)- some people don't realize how fast a stoma can close up, matter of 2-3 hours.

but yes, i have seen those that have come to us with foleys as their fdg tube....and they never last long.

leslie :-D · Mar 17, 2005

When I worked on a NHCU @ a VA, I was trained to reinsert g-tubes that had been pulled out or became occluded. At that time it was actually one of the skills that would be listed on my evaluation. Many of the g-tubes at that time had been long term and were foleys, so that was what I reinserted. I however was speaking with some my current coworkers, who most have never worked anything other than acute care and they were shocked.

shocked at what? that unlicensed assistants were inserting these?

mwaldon · Mar 17, 2005

Looking for anyone who knows about reinserting g-tubes after they become dislodged or pulled out.Can Rn/LPN's reinsert them and are you aware of a policy for it? Is it legal? How is it done? We had a MD tell a nurse to reinsert one until he could get in ,in the morning.Tube feeding was NOT to be restarted .but he wanted the tube in so it would not close up.....Would like to get some opinions on the subject.What is done in nursing home and /or rehab centers for the mentally challenged?? Got any ideas or answers.....AND Hi ,I am an ICU/CCU nurse...we only have a few with g-tubes and have never encountered this before...Thanks[/QUOT
what we do at my facility is use a foley cath (inserted) until one can be replaced by the gastro man! Do not feed through the foley cath, use only as a emergency basis for keeping the track open. :)

Night Angel · Mar 18, 2005

Looking for anyone who knows about reinserting g-tubes after they become dislodged or pulled out.Can Rn/LPN's reinsert them and are you aware of a policy for it? Is it legal? How is it done? We had a MD tell a nurse to reinsert one until he could get in ,in the morning.Tube feeding was NOT to be restarted .but he wanted the tube in so it would not close up.....Would like to get some opinions on the subject.What is done in nursing home and /or rehab centers for the mentally challenged?? Got any ideas or answers.....AND Hi ,I am an ICU/CCU nurse...we only have a few with g-tubes and have never encountered this before...Thanks[/QUOT
what we do at my facility is use a foley cath (inserted) until one can be replaced by the gastro man! Do not feed through the foley cath, use only as a emergency basis for keeping the track open. :)
I've inserted g-tubes or foley catheters as g-tubes in LTC facilities, checked for placement via air and auscultation and never had a problem. But on the other hand, I've worked at an LTC facility where it was forbidden for any nurse to insert one. Instead, the pt was immediately sent to the E.R. for replacement and an x-ray to make sure that it was in place. The administrator of this particular facility said that she had seen too many instances where g-tubes or foley catheters used as g-tubes were misplaced causing the stomach to rupture, and she was not taking any chances in her facility. I work in a hospital now, so we have the G.I. lab to take care of g-tube insertion now. :)

leslie :-D · Mar 19, 2005

I've inserted g-tubes or foley catheters as g-tubes in LTC facilities, checked for placement via air and auscultation and never had a problem. But on the other hand, I've worked at an LTC facility where it was forbidden for any nurse to insert one. Instead, the pt was immediately sent to the E.R. for replacement and an x-ray to make sure that it was in place. The administrator of this particular facility said that she had seen too many instances where g-tubes or foley catheters used as g-tubes were misplaced causing the stomach to rupture, and she was not taking any chances in her facility. I work in a hospital now, so we have the G.I. lab to take care of g-tube insertion now. :)
that's why i find it so scary that uap's would be able to do so. it DOES require skill/judgement.

LPNer · Mar 19, 2005

In other states and in this state in home care, it is acceptable for nurses (RNs and LPNs) to insert a new Gtube when needed. That is both regular g-tubes and buttons.

However, at my current hospital, nurses are not allowed to replace a g-tube. We have to call the house doc, felt bad waking him up for something I went from house to house once a month to do for a long time. OH well. That's nursing.

jennifersusan · Mar 19, 2005

We recently had a patient who was in our ICU on the vent, CRRT for almost a week, with major complications after an MD reinserted his G-Tube which had become dislodged in the long term care facility he was at. The GT was misplaced, and he got over 24 hours of tube feeding into his abdominal cavity (but not stomach) before becoming septic. They believe that he was actually throwing micro-clots of tube feeding all over his body, he had necrotic areas on his forehead, knees, feet, and lost both of his hands. After about 2 1/2 weeks of his being in the ICU, on CRRT, regular runs of hemo-dialysis, continual CV and PV problems resulting from his sepsis, the family decided to withdraw cares.

I have never heard of an MD giving an order to re-insert a GT, (as someone else said - we don't see that very often in the ICU), but I would caution that whoever does this be extremely careful and make certain to confirm placement, and that as an RN taking care of the patient, you always check placement when giving feedings or meds.

LPNer · Mar 19, 2005

We recently had a patient who was in our ICU on the vent, CRRT for almost a week, with major complications after an MD reinserted his G-Tube which had become dislodged in the long term care facility he was at. The GT was misplaced, and he got over 24 hours of tube feeding into his abdominal cavity (but not stomach) before becoming septic. They believe that he was actually throwing micro-clots of tube feeding all over his body, he had necrotic areas on his forehead, knees, feet, and lost both of his hands. After about 2 1/2 weeks of his being in the ICU, on CRRT, regular runs of hemo-dialysis, continual CV and PV problems resulting from his sepsis, the family decided to withdraw cares.

I have never heard of an MD giving an order to re-insert a GT, (as someone else said - we don't see that very often in the ICU), but I would caution that whoever does this be extremely careful and make certain to confirm placement, and that as an RN taking care of the patient, you always check placement when giving feedings or meds.

That was not the fault of nurses, in general, replacing g-tubes. That was the fault of 2 or 3 nurses who didn't bother to check placement in a 24 hour period! Even with a continuous TF running, you check tube placement Q4hours, that is reasonable and prudent nursing practice . If it was not done, it's not the fact that a nurse missed the stomach, it IS a fact that s/he and co-workers did not check the placement before running the feeding and intermittantly while the feeding was running.