Gtube Feedings Help please!!

[RegenerativeNurse]

K so I've got a peds case which requires me to feed them via gtube and administer their medications via gtube as well.

Now my main concern is I've not worked with Peds too much except during my clinicals and even then I never had a pt with a Gtube.

I just want to know exactly how I should go about doing these procedures with a child that is 1yr 7mos.

Is the flush amount for meds for more or less (than 15mL before and 30mL after)?

Is the flush amount between meds more or less (than 5mL)?

How much should, if I should, should I flush prior to feedings?

I'm a bit nervous and would like to know how experienced Ped nurses go about doing these procedures instead of reading a book about it.

[JustBeachyNurse, LPN]

Plus the. 485/care plan should specify the volumes for post med/ post feed flushes and any free water blouses (free water is not common with tube fed infants/toddlers as the fluid requirements are usually met between the enteral formula, liquid meds& flushes)

[RegenerativeNurse, ASN, LPN, RN]

Plus the. 485/care plan should specify the volumes for post med/ post feed flushes and any free water blouses (free water is not common with tube fed infants/toddlers as the fluid requirements are usually met between the enteral formula liquid meds& flushes)[/quote']

I'm going to have the orders clarified bc the nurses handwriting is horrible and i can make out but so much.

I've had patients with some of these diagnoses such as seizure risks and ^ICP, just not in Peds. I'm comfortable with the treatment as well. Especially suctioning, I'm a wiz.

[JustBeachyNurse, LPN]

In another post you stated you are a new grad LPN, hence my statements about nursing orientation and experience. Clinical experience at school is good, but not the same as working independently as a licensed nurse.

Care plans/485 should be typed. All orders should be transcribed to the formal plan of care. Anything not clearly written needs to be clarified.

Remember,suctioning in pediatrics is quite different than sectioning in adults. There are different guidelines and a higher chance of causing tissue trauma. Especially in young patients.

[applewhitern, BSN, RN]

When I worked in pediatric ICU, we rarely flushed any tube feedings with water. Believe it or not, we usually flushed with air! We would push the air with the syringe, then hold the tubing up so the air could escape back out (rather than give them gas!). We very seldom gave free water unless ordered to do so.

[SDALPN]

New grads shouldn't do PDN. Its just not wise until you are experienced. GTs are as easy as a skill gets in PDN. Shaken baby syndrome can be more complex. Its best to gain experience for the patients safety and to protect your license. Also, some agencies will lie and say you have experience when you don't have a year of experience and its insurance fraud. You can lose your license and get charged with fraud if the patients insurance requires experience. You should be discussing this with your supervisor as well as taking with your supervisor about your questions on how to do skills. Most of us on this board are competent. But do you really trust your license with a bunch of "strangers"telling you how to do nursing skills over the internet? What if the gt falls out or gets pulled out? Can you reinsert it? What if it happens and your supervisor is caught in traffic with a dead cell battery and forgot her charger that day? Now your back up isn't available and you patients stoma is closing and you may not have inserted a gt before. On top of that, kids change really fast. Just a few things to think about. You may want to read other posts about new grads trying to do PDN.

[RegenerativeNurse, ASN, LPN, RN]

In another post you stated you are a new grad LPN, hence my statements about nursing orientation and experience. Clinical experience at school is good, but not the same as working independently as a licensed nurse.

Care plans/485 should be typed. All orders should be transcribed to the formal plan of care. Anything not clearly written needs to be clarified.

Remember,suctioning in pediatrics is quite different than sectioning in adults. There are different guidelines and a higher chance of causing tissue trauma. Especially in young patients.

They are hand written and not completely legible hence my confusion. I see only 100mL post feed, so I'll not be giving any more than that. I am awaiting the discharge papers which i hope are much clearer.

And i understand my being a recent graduate makes this risky business. I was hoping to get someone to walk me through at least halfway but I'll be the first nurse to care for the child once discharged.

[JustBeachyNurse, LPN]

Who saw the client to admit them to the agency? It should have been an RN or RN clinical supervisor. There should be clear and specific orders for admission especially for medications and enteral feeds/fluids. In addition, before the first nurse arrives to care for the child a MAR, care plan and chart should be created by an RN.

Call the physician for clarification. 100mL post feed for a toddler with risk for ICP and shaken baby sounds off based upon my experience. Maybe 10mL...but it also depends on a lot of factors such as feed volume, type of formula, other sources of fluids and , medications given.

I would NOT rely on the discharge paperwork sent home with the patient as this is often lacking in valid orders for skilled nursing.

As an LPN, I've been the first nurse post discharge but the client was always evaluated prior to my arrival even if the RN clinical supervisor went to the hospital to do the admission. The nurse case manager/discharge planner at the hospital coordinated the home skilled nursing care with the clinical supervisor at the agency. I was able to review the 485/plan of care even if a draft version before seeing the patient this way any questions could be answered up front. I've also done a late evening visit and met the RN for start of care. Phone calls were made to the attending and on-call physician to clarify any ambiguous or questionable orders and obtain any missing orders (sometimes simple orders like tylenol or ibuprofen dosing are missed when a client is a new to agency)

My one agency gets a lot of referrals from some of the regional pediatric hospitals so the residents on call almost expect us to call post discharge for clarification of care plans and orders. Especially if the home discharge papers don't match the initial orders in the 485.

Call the nurse who is responsible for opening the case for clarification before you go to the patient's home. If the discharge papers don't match the orders/care plan/MAR call your clinical manager right away. This is why clinical RN managers are on call.

[Hotfornursing, RN]

100 ml flush post feed for a infant, WOW!!!...I would definitely get clarification on that order. We did post feed flush for a 10 y/o, only 60 ml via GT.

[JustBeachyNurse, LPN]

I have 16 year olds with 30-60ml flushes. Under age 2 definitely clarify. !!

[systoly]

i can only repeat what others have said

even if i saw a printed order for 100 ml flush

i would call the doc and find out first hand

remember, this is a new admit

[edmia, BSN, RN]

This whole scenario does not sound safe at all. I'm sorry OP, but this case is beyond your current skill level. Ethically, you should refuse it or request proper orientation.

Sent from my iPhone using allnurses.com

[Elle23]

Thank you guys!

I actually won't get a walk through from anyone, I just 'start' this Saturday which is a little nerve racking.

That is insane. I am an experienced nurse, and I would never take a case like that without a thorough orientantion.