Diarrhea & G tubes

[pielęgniarka]

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!

[pielęgniarka, RN]

To answer the questions in response to my original post:

I mentioned already that the feedings for the pt I am wondering about run for 8 or 12 hours.

Night nurse hand fills the feeding bag with cans of formula to run on a pump. Total infusion is like 1220 mls.

The dietician was already consulted and is the one that started the benefiber which may have helped some.

MD has been consulted many times and med changes were made and different formula types implemented etc.

Thank you for all your responses so far!

[Magsulfate, BSN, RN]

WEll, hey, does it really matter if you have the same brand TF in a spiked bag, or if you pour the same formula from a can into a sterile bag and close it???

It doesn't seem like there would be a difference.

Thats why I just fill up the bag with 4 cans, and run it until it's gone, or until 24 hrs is up. Then I'll change the bag and tubing and start over. Same with the spiked bags.

[RN1982]

I think some of the tube feeding formulas cause diarrhea in some patients, usually we'll have the dietician order benefiber or change to a different formula.

[KyPinkRN]

WEll, hey, does it really matter if you have the same brand TF in a spiked bag, or if you pour the same formula from a can into a sterile bag and close it???

It doesn't seem like there would be a difference.

Thats why I just fill up the bag with 4 cans, and run it until it's gone, or until 24 hrs is up. Then I'll change the bag and tubing and start over. Same with the spiked bags.

It does matter whether its a closed system, sterilized formula is filled in a factory then spiked as opposed to filling at the bedside, where there is more opportunity for microorganisms to get in. The cans are meant to be consumed in a certain period of time, thats why they say discard after opening for such and such a time.

Here is an article I found which explains the differences pretty well...

http://findarticles.com/p/articles/mi_m0FSS/is_n6_v5/ai_n18607104