A bunch of questions!

[NurseyPoo7]

pegs:

i know when someone has a new peg, their drsg needs to be changed at least q day, but what about someone who doesnt have a new peg? and when is a peg considered not "new" anymore?

i'm used to having pegs drain by gravity (esp with bolus feeds) but ive seen a lot of nurses push meds and such thru the peg... esp if they have to give crushed tablets (or that horrible mvi powder... that orange crap that stains everything), which often "settle" and end up clogged up the tube if they arent drained quickly. is this acceptable?

is it really necessary to check placement of a peg tube? i know if it had been dislodged you'd often see signs of infection/rigid abd... i understand with ngt you def. need to check placement, but what about a peg since its surgically placed?

i have a little notebook called rn notes and under the feeding tube section written in red it says do not instill meat tenderizer - can cause metabolic complications or allergic rxns. what is this all about?

pulling piccs:

ive heard some nurses say when pulling a picc to tell the pt either to:

1) bear down like a bm

2) cough

3) hold their breath

whats correct?

can anyone run down chest tubes with me? ive never had to deal with one. a gentle bubbling is good right? and if the ct becomes dislodged, you are supposed to put petroleum gauze over it correct?

i had a pt who had a large diabetic ulcer on the bottom of their foot and the rx'd drsg change said to pack it with xeroform, which is basically like pet. gauze. was the purpose of that to keep the ulcer moist or is am i not understanding the function of xeroform?

when giving kcl and mag runs, i monitor their bp at least q 15 since they can both cause hypotension... but ive had other nurses tell me i'm wasting my time. what do you do?

[Daytonite, BSN, RN]

i had a pt who had a large diabetic ulcer on the bottom of their foot and the rx'd drsg change said to pack it with xeroform, which is basically like petroleum gauze. was the purpose of that to keep the ulcer moist or is am i not understanding the function of xeroform?

xeroform is one brand of petroleum gauze. it is being used to keep the wound moist and prevent hypergranulation as the wound heals.

http://www.acponline.org/clinical_information/journals_publications/acp_hospitalist/july07/pressure_ulcers.htm

for information on wounds see this website:

http://www.worldwidewounds.com/

- world wide wounds

when giving kcl and mag runs, i monitor their bp at least q 15 since they can both cause hypotension... but ive had other nurses tell me i'm wasting my time.

with kcl i'd be more concerned about the patient going bradycardic! most hospitals won't allow kcl boluses to infuse without the patient being on telemetry. the iv site also needs to be monitored for extravasation and the patient for complaints of burning and stinging. hypotension is a side effect and i personally would do a bp at the start of the infusion, but not q15minutes. hypotension is a symptom of shock or hemorrhage. i would watch for symptoms of hypotension: change in loc, nausea, chest pain, pallor, sweating, clamminess, abnormal heart rate and rhythm (which you should already be monitoring), patient complaint of dizziness.

with magnesium sulfate hypotension and asystole will occur if it is infused too rapidly. as with kcl i would do a bp at the start of the infusion and then watch for symptoms of hypotension.

[CoffeeRTC, BSN, RN]

Never, never, never put meds into the feeding bag.

I havent seen a tube feeding clog in yrs. If you do a search, there was a thread a few weeks ago about this. Biggest thing to remember...warm water to disolve the crushed meds and use enough water to flush.

Where do you get the meat tenderizer in the hospital?

[ktwlpn, LPN]

Don't forget to heck your policy and procedure manual and make sure you are following it.

[Penelope_Pitstop, BSN, RN]

where do you get the meat tenderizer in the hospital?

the pharmacy prepared it for us. it was called "clot buster" or something to that effect.

jess