Do you need to check placement before using a Bard Button or a Mic-key

[changeseeker]

Hello,

I'm wondering what the current practice is for low profile g-tubes. I have 1 client with a Mic-key and another with a Bard Button. The Mic-Key booklet says to check tube placement before using the tube each time. It's pretty easy to do because the stomach contents just back up in the extension tube each time we hook it up.

For the Bard Button though, it won't work. I've heard it has a one way valve, so does that mean we can't check for stomach contents or even check for residuals?

I'm training caregivers to do the tube feeding and I've been telling them to check for placement, but it's impossible with the Bard button. is there something wrong with it or is it not possible?

Thanks for any help.

[Bug Out, BSN]

Always verify placement before infusing, very high risk of peritonitis if you don't. Verify through auscultation. My facility is moving away from verification by aspiration and going primarily to auscultation since it is difficult to tell if the contents aspirated are from the peritoneal cavity or the stomache.

P.S. IIRC you can aspirate through a Bard button, it just requires a certain negative pressure to overcome the valve.

See what happens when you get lazy and don't verify placement.

http://www.nso.com/case-studies/article/105.jsp

[CNL2B]

Maybe I'm backwards, but I have NEVER in my career checked placement of any type of gastrostomy tube. They are surgically placed and should be in the stomach, held in by a balloon. NG tubes and small bore NJ tubes for feeding, absolutely I ascultate and also check the marking at the nares.

I haven't seen anyone in practice actually check placement of a PEG, and this is not the standard of care where I work or anywhere else I've worked. I never learned it in any nursing orientation I've ever been through. I didn't learn it in school, either. Not saying it's wrong, and certainly a PEG could slip out of place, but I've never seen that happen, either.

That said, obviously (from previous poster) it does happen on occasion.

[suanna]

Maybe I'm backwards, but I have NEVER in my career checked placement of any type of gastrostomy tube. They are surgically placed and should be in the stomach, held in by a balloon. NG tubes and small bore NJ tubes for feeding, absolutely I ascultate and also check the marking at the nares.

I haven't seen anyone in practice actually check placement of a PEG, and this is not the standard of care where I work or anywhere else I've worked. I never learned it in any nursing orientation I've ever been through. I didn't learn it in school, either. Not saying it's wrong, and certainly a PEG could slip out of place, but I've never seen that happen, either.

That said, obviously (from previous poster) it does happen on occasion.

My experience is the same as yours- Cor-Pac tubes, Salem Sumps, Any NG or OG tube is checked Q shift and before each use by auscultation, and initially by KUB, I have never heard of auscultating a PEG or PEJ tube- What difference would there be between the sound of air injected into a stomach, or the peritoneal space? Aspiration and PH testing are fine gastric VS tracheal placement, but if there is little or no aspirate am I to assume the G tube is missplaced? Wouldn't the PH of any aspirate be acidotic if the G-tube left a opening to the peritoneum? Interesting thread- I'll keep following.

[realnursealso/LPN, LPN]

"Defendant denied falling below the standard of care, advancing the defense that the feeding tube was misplaced by the physician, and the resulting peritonitis was not caused by neglect or abuse."

"

"According to the Trial Reporter of Central & Northern Arizona, one month before trial, plaintiff accepted a $25,000 offer of judgment on her wrongful death claim against defendant. On the claims of neglect and elder abuse, after plaintiff's closing arguments the matter settled for $850,000. "

Nothing happened to the nurses, the person "settled" as per this article.

[anon456, BSN, RN]

Once you put the extension tube on the Bard button, it bypasses the anti-reflux valve and should be easy to aspirate gastric contents. The Mic-key button is supposed to have an anti-reflux valve but they blow within days.

On an empty stomach you may not get any secretions through aspiration though. That has been my experience.

[anon456, BSN, RN]

"Defendant denied falling below the standard of care, advancing the defense that the feeding tube was misplaced by the physician, and the resulting peritonitis was not caused by neglect or abuse."

"

"According to the Trial Reporter of Central & Northern Arizona, one month before trial, plaintiff accepted a $25,000 offer of judgment on her wrongful death claim against defendant. On the claims of neglect and elder abuse, after plaintiff's closing arguments the matter settled for $850,000. "

Nothing happened to the nurses, the person "settled" as per this article.

Especially after surgery the placement should be checked for initial feedings, but on an patient who has had a PEG tube for a long period of time it should not be necessary unless they have just had surgery or some other procedure that could alter placement.

[CNL2B]

"Defendant denied falling below the standard of care, advancing the defense that the feeding tube was misplaced by the physician, and the resulting peritonitis was not caused by neglect or abuse."

"

"According to the Trial Reporter of Central & Northern Arizona, one month before trial, plaintiff accepted a $25,000 offer of judgment on her wrongful death claim against defendant. On the claims of neglect and elder abuse, after plaintiff's closing arguments the matter settled for $850,000. "

Nothing happened to the nurses, the person "settled" as per this article.

It was hard for me to tell whether or not from this article they went after the NURSES who were using the tube that had been incorrectly placed or the PHYSICIAN who misplaced it, or the NURSING HOME that supervised and set the standard of care for the nurses. So, the tube was incorrectly placed. That sounds like MD malpractice to me, not a nursing problem.

[ShannonRN2010, BSN, RN]

My brother had the Mic-Key J-tube place about 2 months ago...twice. He's managed to puke the stupid thing up...twice! and have it come out his mouth.

So um...yeah if he gets another one, I'll be checking placement!

[Bug Out, BSN]

They did not go after the Nurses, no money in LPNs.

The facilties policy is to check placement of every feeding tube, no matter the type before every single feeding or use. Weird you guys do not check placement, I was taught in school to check placement, state surveyors check to see if we are checking placement, the pharmacy recommends we check placement...must be different in your states.

How else do you know if the tube has been dislodged or remains in place?

Yes the facility attempted to pin it on the MD, someone has to be blamed.

The defendent was the Nursing home.

[Bug Out, BSN]

Maybe I'm backwards, but I have NEVER in my career checked placement of any type of gastrostomy tube. They are surgically placed and should be in the stomach, held in by a balloon. NG tubes and small bore NJ tubes for feeding, absolutely I ascultate and also check the marking at the nares.

I haven't seen anyone in practice actually check placement of a PEG, and this is not the standard of care where I work or anywhere else I've worked. I never learned it in any nursing orientation I've ever been through. I didn't learn it in school, either. Not saying it's wrong, and certainly a PEG could slip out of place, but I've never seen that happen, either.

That said, obviously (from previous poster) it does happen on occasion.

I think this may be the difference between acute care and long term.

In Nursing homes often times the people are well enough to pull on their...well everything. PEGs, NGs, buttons what have you. Doesn't matter if the balloon is the size of an orange, they still manage to yank the darn things out. Doesn't matter if they are sutured in, a good yank by a confused resident will dislodge most anything.