Do you need an order to flush a G-tube?

[somedaypeds]

My pediatric home care pt (baby) has a g/j. With history of aspiration, everything goes in the j (kid has a trach). We flush the J before and after meds and q 4 hrs. There is no order or mention to flush or not flush the g. I have been flushing with 3 mL water each time I flush the j - with no problems. The other nurse on the case does not flush the G and frequently reports gastric juices in the G line. I have no problems with gastric juices or the pt aspirating the small amount I use. I guess I thought flushing a port was always done to keep it patent. Do you need an order? Am I doing something wrong here by flushing the g?

[NurseLoveJoy88, ASN, RN]

There should be an order for flushing. I worked peds home health and always had orders...

[LoveMyBugs, BSN, CNA, RN]

There should be an order for flushing if you are not putting anything in it. I work peds LTC and all of our kids have either a G, J or G/J tube, if the Gt doesn't have anything going in it like meds or feedings then it is usually left open to a bag to vent....to which there is an order.

When you have such little patients they can asiprate the 3ml you are putting in there. When they have a tach there is even a higher risk of aspiration, we have one kiddo who you could see his med (red) coming out of the trach just minutes after it was put in the G-tube, which is why he has a J-tube.

How often are you putting in the 3mls while it may not seem like much to you, but those 3 mls need to be considered when thinking of the diet orders, our dietatican calculates our flushes when making feeding adjustments

[caliotter3]

Simply call the doctor and get an order, easy enough.

[Sehille4774]

Yup...I agree with the other posters. Took care of a 16yr old and 2 yr old with a g-j tube. One had an order NEVER to put anything in the g-port, the 2 yr old we could flush the g-port with 3-5ml prn, but we didn't do it regularly. So that is one I would clarify to see what the DR wants.

[LizAnn]

There is also probably a policy/procedure @ your home care company that refers to flushing G tubes. That could be a good reference point to help you determine how the order should be written, in case MD needs assistance.

[somedaypeds]

Thank you for all of your responses. The child used to have a bag to vent, but it was dc'd. I guess the doc should have said at that time whether or not to flush. (I did not accompany child to appt). So, call home care company about policy, then call doctor and clarify.

[9livesRN, BSN, RN]

Use your nursing judgement! Old kid? can handle standard flush? If so flush it and ask for an order ( better than have to ask for another tube placement or declog) if not call the doctor STAT the, use SBAR and see what he or she wants to do!

[KelRN215, BSN, RN]

My first thought reading the title to this thread was "do you need an order to give a patient a glass of water?" The vast majority of my patients who have G-tubes don't end up having orders to flush them but we do it as a standard of care after giving meds, feeds,etc so as to not clog the tube. However, since it is a patient with a G/J tube, trach with nothing going through the G, I personally would not assume I should be flushing the G. Most patients I know with G/J tubes have very specific guidelines... G tube to drainage, G-tube for meds only, etc. There is a reason why they have a G/J and not just a G, after all....

[pinkfluffybunny]

I am gonna say get an order esp if a pt has a risk for aspiration. If something goes wrong for example your pt aspirates, you need orders to cover your butt.