Do you think removing an NG tube is "killing someone"?

[krenee]

I am a nursing student and at my patient the other day at clinical was comatose, after a stroke and has been in the same condition for several weeks now. The nurse told me he was being place on hospice and the doctor ordered removal of his NG tube and d/c's most of his meds. I was going to remove the NG tube, but the nurse became uncomfortable because I hadn't done it before, so she did it herself. So while I realized basically what was going on, I clarified with my instructor . . . he now has no feeding tube, and he has no IV fluids going in . . . obviously they are going to let him die. I was talking to my mom on the phone later on and mentioned the situation, and she said, "I'm so glad you didn't kill that man", meaning I didn't remove the NG tube myself as I was going to.

IDK, I really hadn't thought about it that *I* would be killing him by doing that . . . first, the family made the decision, then the doctor gave the order . . . but I guess I can see her point.

Just curious how other nurses feel and deal with situations like that.

[Tom123]

The decision to remove the NG tube has been made by the family. The patient, himself, may have made the decision prior to having a stroke. That is the purpose of a Living Will. It allows us to make those decisions, so the family will not be stuck with it. It allows children to follow the parent's wishes, rather than have the guilt. They are doing what mom/dad wants to have done.

Death and Dying is a difficult topic for some nursing students. It needs to be discussed openly. One day you may find yourself in the position of removing life support systems from a patient. The patient will have made these decisions, or there NOK, or designated surrogate will made the decisions. Before you can help a patient face death, you must first face your on death.

I have taught BioMedical Ethics for several years. I would recommend that you write your own obituary. This sounds rather morbid, but it does put you in the position of facing your death. Once we understand, and really understand, that all of us will die, then we can help a patient, family member, friend, face their death, or the death of a loved one.

Read Kubler-Rose's book On Death and Dying. It will help you understand more.

Keep up the good work, and best wishes.

[krenee]

A lot of ethical issues in health care can - like removing an NG tube - present like routine tasks, and it's not until someone draws attention to the potential ethical dimensions of the act that we even realise there's more to it. For a lot of nurses, particularly those without much experience, the discovery that they didn't just remove an NG tube (hang a flask of analgesia etc) but participated in a chain of events that possibly hastened a patient's death can be distressing.

.

Thank you - that's exactly how it was! I was just thinking, cool, I can remove the NG tube, and I would have if the nurse hadn't wanted to do it herself . . . then I started thinking afterwards about hey, how is he going to get nutrition? But I had cared for him for several weeks and though a great deal about how sad his situation was, and I was certain that no one wants to live like that. Someone in his family apparently made the decision, but they weren't present, for whatever reason . . . he was all alone. It was very sad. And he wasn't tolerating the feedings well, his abdomen was very distended and firm. I'm sure that had I been fully thinking about the situation, I still agree with removing the NG tube. And I told my husband I would want the same thing done if it were me.

[blondy2061h, MSN, RN]

There's a difference between killing someone and stopping intervention that's artificially keeping them alive.

[Scubadiver]

I can't say enough thank you's for your response. I am a certified palliaitve care and hospice nurse. I work in an acute care hospital where I am the one responsible for giving the order to stop meds etc. The nurses thank me. Living involves having the capacity to make decisions. Being in a vegetative state does not denote living. That's just existing. I'd never want that for myself or anyone I cared for...

[leslie :-D]

And he wasn't tolerating the feedings well, his abdomen was very distended and firm.

just this one piece of information, is enough to tell me that aspiration would have happened shortly thereafter.

what can't go down, will come up.

it was an extremely humane act of kindness in removing that tube.

you folks prevented a lot of pain and distress in this pt.

and i'm relieved to know you are seeing the 'big picture'.:icon_hug:

nursing has to be one of the most humbling professions out there.

now this man can die in peace.

thank you.

leslie

[Virgo_RN, BSN, RN]

No, not killing. An act of compassion is what it is. I would have been honored to remove that tube.

[systoly]

The NG tube would have had to been replaced at one point anyway so technically it is the decision of not placing a permanent tube that makes the difference. Pulling the NG tube relieved discomfort and tissue irritation. As far as "killing someone" is concerned, I'd like to ask that person two questions: how do you define life?, and, do you suppose another person might give a different, yet valid definition?

[GooeyRN, ADN, BSN, CNA, LPN, RN]

It isn't killing them if they are obviously going to die soon anyway. The disease is killing them. You are making them more comfortable. If his abdomen was firm, he would aspirate soon, then get pneumonia, etc. I personally couldn't pull the tube on someone that woulld live a long time if the tube were left in place, though.

[massrn116]

We struggle with the death and dying issue all the time. Like other posts, I have stopped ventilators, feedings, meds etc. then started the morphine drip. In my mind I have to say I am keeping the patient comfortable. It is extremely frustrating when someone comes in a DNR and most doctors where I work state that does not mean do not treat. They go to the family and generally ask, "do you want us to help your loved one" instead of saying "I noticed your loved one is a do not resuscitate, this would be a good time for me to offer you comfort measures." When we treat the DNR, we are hanging pressors, antibiotics, sticking in central lines, getting abgs, feeding tubes, bipap if necessary. All the while I feel we are going against the patient's original wishes. When the body can no longer take nourishment on its own, it means it is naturally shutting down. It is time. I tell families one of the most loving and hardest thing they can do is to honor their loved ones wishes to be let go with dignity. Sometimes it is all in the way it is presented.

[Neveranurseagain, RN]

Only in America is it considered a failure to die...it is natural part of life and quality of life is imperative. 4 years ago I had to make the decision to dc the vent and refuse a feeding tube on my 47 yo husband after a medical incident. He was breathing 1 times a min, had blown his pupils and had decortacate posturing. The next step was a feeding tube and transfer to a SNF. Instead, I made the kindest decision of all and he became a DCD (donor after cardiac death) after the vent was DC. I hope someone is as kind to me someday. Then I went home and told our 9 and 10 year old....

[nerdtonurse?, BSN, RN]

That was my thought -- I've had patients who had lost bowel sounds, more dead than alive, and the family demanding we keep feeding them (and we've got one doc who'd put a PEG tube in a cadaver). Here's what could have happened to your patient.

You're doing a feeding, and in the process of assessing placement, you hear rhonchi in all lung fields (yes, I'm neurotic, I check placement, and then listen to the lungs). Because the patient can't protect their airway and the spincters are relaxed, the food's just coming up the esophagus and pouring into the lungs. When you suction, you pull up Jevity or Glucerna or whatever. There no bowel sounds. Your patient has fecal breath. The abdomen keeps getting bigger and bigger from a paralytic illeus (because their intestines have stopped working, and are now dying). What happens if the doc makes you keep feeding the patient is you drown the patient in their Jevity. If the patient is aware, the last sensations they have are intense pain in the abdomen as the fecal material builds and creates large amounts of gas, and the sensation of drowning and suffocating.

The alternative is you pull the feeding tube, the patient's blood sugar falls to a point where they become comatose, and they drift off to sleep. After a while (dependent on their overall reserves, how much the liver can do to free up glucose, etc.), they simply wind down and stop. Personally, I'd rather die in a coma than feeling like I'm drowning and can't cough the garbage in my lungs up...

[cardiacRN2006, ADN, RN]

Only in America is it considered a failure to die...it is natural part of life and quality of life is imperative. 4 years ago I had to make the decision to dc the vent and refuse a feeding tube on my 47 yo husband after a medical incident. He was breathing 1 times a min, had blown his pupils and had decortacate posturing. The next step was a feeding tube and transfer to a SNF. Instead, I made the kindest decision of all and he became a DCD (donor after cardiac death) after the vent was DC. I hope someone is as kind to me someday. Then I went home and told our 9 and 10 year old....

:redbeathe Sorry to hear about your husband...