Diarrhea & G tubes

[pielęgniarka, RN]

So here I am on my weekend off thinking about work: my question for you: I was taught in home care to only have 4 hrs of forumula at a time in the tube feeding bag to minimize bacterial growth. Place I work at now is filling the bag for the whole 8 hour (recently changed to 12hr) overnight pump infusion..... not on ice or anything. Cans are at room temp. The pt also has chronic diarrhea.... I just now thought that diarrhea may be caused by this tube feeding practice. The MD has assessed the diarrhea many times before and adjusted pt drip rate, forumula type, meds, added benefiber, etc. On the can for the forumla it states to 'refrigerate after opening' but does not state how long it can be safe at room temp. I would imagine that regular food standard practices would apply.... I'll get a trial going and get the routine changed to fill Q 4hrs when I go to work tomorrow but I wanted to know what your thoughts are. Is it common practice fill the bag up for the 8-12 hour infusions or do you replenish in 4 hour increments? (The pt does not take anything PO because of aspiration and has had the tube for over a year.) Thanks!

[lpnflorida]

Our continuous tube feeds, use the 1000cc bottles, no they are not on ice. They are changed every 24 hours along with the tubing.You bring up a very good point. I wonder if it makes a difference or not.

[KyPinkRN]

At my work we recently started using plastic bottles that can hang for up to 48 hours. Perhaps the formula is prepared to decrease the bacterial growth... still goes against everything we've been taught, especially since the saline we hang even has to be changed every 24.

[pielęgniarka, RN]

Yeah, that's weird to me too. 48 hr infusions of anything not being changed out... even if the spike going into the bottle is sterile... I wonder what the chemical make up of those bottles are?

At my work we recently started using plastic bottles that can hang for up to 48 hours. Perhaps the formula is prepared to decrease the bacterial growth... still goes against everything we've been taught, especially since the saline we hang even has to be changed every 24.

[chechi22]

I'm just a student but we were taught they shouldn't hang for more than 4 hr increments either...

[lpnflorida]

http://rpdcon40.abbott.com/mn/Ross%20MN%20Nutritional%20Products.nsf/e6c5e488b0ee332a852572b1005e989c/0f557093e2c3b37485257203004cfb3e/$FILE/Ross_Ready_To_Hang_setup.pdf

according to manufactuer, the 1000cc bottle can hang up to 48 hours

[leslie :-D]

we change them q 24 hrs, per p&p...

and when someone has diarrhea or other problems, we get our dietitian involved.

poor guy,

leslie

[lpnflorida]

Is your patient on continuous feed or bolus feedings. Sometimes bolus feedings can cause a dumping syndrome. Diarrhea seems to be more of a problem the first week of a new tube feeder than we see in someone who is weeks out. They might not be tolerating the particular formula, I agree get a dietician involved and the doctor.

[RN1982]

Where I work, we are not suppose to hang more than 8 hours of tubefeeds. After the eight hours of tube feeds have been infused, we are suppose to rinse the bag out with sterile water.

[lpnflorida]

Is this perhaps the reason we are seeing different policies in regards to how long a tube feeding can hang? A closed system versus hand filled bag?

[RN1982]

Could be. I have to hand-fill my tubefeeds.

[KyPinkRN]

Is this perhaps the reason we are seeing different policies in regards to how long a tube feeding can hang? A closed system versus hand filled bag?

Ours is a closed system...