dislodged G-tubes

  1. 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
    •  
  2. 29 Comments

  3. by   CHATSDALE
    we reinsert c a foley to maintain patency....we usually wait 4 hours before starting a drip or a bolus.....this is facility policy...i know that other places may have different policies...we verify with air or aspiration...if you are unsure get an x-ray...some places insist on xrays with every insertion...i would prefer to err on the safest way but i have heard it said that a tube can be dislodged minutes p an x-ray so you are going to have to verify anyway...not much of an answer but this is the day to day work hope it helps
  4. by   leslie :-D
    where i worked, rns inserted g tubes all the time- perfectly fine with the mds. i believe we used flexiflo gastrostomy tubes, different sizes according to what pt had. there's really nothing to it... and it's confirmed by swishing 10 cc of air. initially there's minimal bleeding at the site but we still resumed their fdgs or gave them their meds, with no waiting period. the most important thing is to ensure the stoma doesn't close- they close so quickly that there have been patients that had to be sent out to have the stoma reopened, all very preventable.

    leslie
  5. by   steelcityrn
    I work in home settings and change them monthly, or prn if the balloon was to rupture. Its no big deal, usually use a 20f (adults)...You just lube, incert and instill water in ballon ( normally 5cc). Apply your wafer(holding device ), date and initial. Then you check placement as stated above, 5cc air and listen with steth. Your good to go.....
    Last edit by steelcityrn on Feb 15, '05
  6. by   braininjryRN
    QUOTE=safc1111]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[/QUOTE

    Where I work which is an assisted living facility I train the staff who are not licensed to re-insert G-tubes. I teach them just like I was taught including checking for placement post insertion and pre- medication administration or feeding. [
  7. by   DDRN4me
    I have been inserting g-tubes of various types for many years..it depends on your facilitiy's policy. most of the new buttons and Mic-key tubes do not migrate, which is nice. foleys can and do. You should always check placement before any feeding or med.
  8. by   leslie :-D
    QUOTE=safc1111]

    Where I work which is an assisted living facility I train the staff who are not licensed to re-insert G-tubes. I teach them just like I was taught including checking for placement post insertion and pre- medication administration or feeding. [[/QUOTE]

    i respectfully disagree with unlicensed staff inserting g-tubes.
    it is definitely a skilled procedure and should not be delegated to nsg. assts. or anyone that's not licensed.

    leslie
  9. by   mommatrauma
    We are allowed to replace it with a foley catheter in the ED, however before it is used for any type of feeding the pt has to go to xry and have a gastrograffen study done to verify placement...
  10. by   Speculating
    Quote from earle58
    QUOTE=safc1111]

    Where I work which is an assisted living facility I train the staff who are not licensed to re-insert G-tubes. I teach them just like I was taught including checking for placement post insertion and pre- medication administration or feeding. [
    i respectfully disagree with unlicensed staff inserting g-tubes.
    it is definitely a skilled procedure and should not be delegated to nsg. assts. or anyone that's not licensed.

    leslie[/QUOTE]

    I believe it to be beyond the Scope of Practice for LPN's and lower. It's pushing the profession of RN to place a new G-tube.
  11. by   barefootlady
    If a g tube is dislodged, then you must insert a tube, at least a foley into the site to prevent closure of opening that would cause patient to undergo another procedure to insert a g tube surgically. It is not hard, perhaps your facility will give an inservice. Always check for placement by aspiration and air. Never start fluids if you are uncertain, recall doctor if necessary. Meanwhile, make sure patient's hob is 15 to 30*.
  12. by   braininjryRN
    Quote from earle58
    QUOTE=safc1111]

    Where I work which is an assisted living facility I train the staff who are not licensed to re-insert G-tubes. I teach them just like I was taught including checking for placement post insertion and pre- medication administration or feeding. [
    i respectfully disagree with unlicensed staff inserting g-tubes.
    it is definitely a skilled procedure and should not be delegated to nsg. assts. or anyone that's not licensed.

    leslie[/QUOTE]

    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.
  13. by   Tweety
    Unlicensed staff here insert foley's so it's not a stretch for them to reinsert a dislodged g-tube. However, that isn't something I would choose to delegate, I would do it myself and have on several occasions. It's not one of those tasks on the techs check off lists.

    We have a radiology test, "g-tube insertion" or something like that, that we can order after we reinsert a tube. They inject gastrograffin or something like that to check for patency and leakage, afterwhich we can restart the tube feeding. An MD need not be involved, except to give the order to re-insert and for the xray.

    I only pre-sume this is o.k. with the nurse practice act. Silly me.
  14. by   leslie :-D
    Quote from braininjryRN

    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

close