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G-tube Flush

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stkn1 stkn1 (New) New

Hi all. There seems to be some controversy on how to flush a g-tube at my facility. One supervisor says flushes should be bolus, another says injected with plunger. Floor nurses have varying opinions on the subject. I found a patient education pamphlet for discharge which shows injection for a flush, but since it seems to be an ongoing debate here, I was wondering how all of the nurses that visit this site felt about it. Just an FYI, no one debates that feedings should be bolus if not using a pump, we all agree on that!:specs:

We use a kangaroo syringe when flushing peg tube with water or giving medicine. I was told never to use syringe plunger to inject water or medication becuase if its injected too fast patient it will cause nause and patient can vomit and I've seen it. When the state surveyors are watching giving meds via peg tube, we are always to let it flow in by gravity, never use plunger which is frustrating when water wont flush when mixture of medication clogs the peg tube and it wont flush. But if we use plunger to inject anything into a peg tube we will be sited by the state. :redlight::redlight::redlight:

We flush peg tube with bolus of water. The order states to flush peg tube with 200cc of water q shift, and we pour 200cc of water.

Edited by Ms.RN

gt4everpn, BSN, RN

Specializes in Licensed Practical Nurse.

Yes from what I've learned it is to be flushed by gravity esp when the state is there.. To be very honest I have 40 patients plus about 10 peg feeders and other things to do and I usually bolus or inject it because often it doesnt flow fast enough by gravity plus it prevents clogging. I have never had a patient aspirate or vomit when I inject it.. but I do realize that it may cause aspiration pnuemonia.

tothepointeLVN, LVN

Specializes in Hospice / Ambulatory Clinic. Has 3 years experience.

I'm still new to nursing but I pull up with a plunger but then let it go by gravity but if it gets stuck then you already have the plunger in place. I have tiny hand shakes and splash water everywhere without the plunger in place. This was the way one instructor taought me but they are all different

In reply to the question of flush or not to flush flush is a flush piston syringe toclear to tube with warm water the patient has to be forty degrees up or they will aspirate, in regard to admin meds bolus meds one at a time that is the proper way to do it in my region Any takers?

Pepper The Cat, BSN, RN

Specializes in Gerontology. Has 35 years experience.

I always use a syringe. I believe you need the extra "push" to make sure meds don't adhere to the sides and cause blockage. I also always use at least 100 cc of water, to make sure the g-tube is clear. I've never had a pt vomit while I did this. I have encountered block g-tubes because the nurse before did not flush it well after meds.

I'm confused. I have a patient with a tube that is referred to by fellow nurses as peg tube or j tube, depending on who's talking. I'm not sure exactly what kind of tube it is.

Whatever it is, if I don't use a syringe to force a bolus of Gatorade down that tube, nothing's going down that tube. Gravity will not suffice, and no matter how carefully I give that bolus, some will overflow out of this tiny tube, anyway. (I believe it's a Kelly surgical tube.) The doctor's order stipulates that we are to flush the tube with 30 mL of free water before and after drugs or any bolus. It does not, however, say how those liquids are to be administered. All of the nurses use the syringe to push.

So is it incorrect to use the syringe in this manner?

SunnyAndrsn

Specializes in LTC/Rehab, Med Surg, Home Care.

We do flush, as the pt. we have uses Jevity at a low flow rate, and Jevity tends to clog the tube very easy. Therefore, we do the flush with warm water (and also do cola flushes 2x a week) to keep the tube patent. He needs flushes every four hours, and stills gets clogged if we're too late. Hate that darn Jevity, wish we could go back to the Fibersure.

SunnyAndrsn

Specializes in LTC/Rehab, Med Surg, Home Care.

I'm confused. I have a patient with a tube that is referred to by fellow nurses as peg tube or j tube, depending on who's talking. I'm not sure exactly what kind of tube it is.

Whatever it is, if I don't use a syringe to force a bolus of Gatorade down that tube, nothing's going down that tube. Gravity will not suffice, and no matter how carefully I give that bolus, some will overflow out of this tiny tube, anyway. (I believe it's a Kelly surgical tube.) The doctor's order stipulates that we are to flush the tube with 30 mL of free water before and after drugs or any bolus. It does not, however, say how those liquids are to be administered. All of the nurses use the syringe to push.

So is it incorrect to use the syringe in this manner?

My other pt. has a G-J tube, with one port in his stomach, the other in the jejunum. I use syringes to push his medications, as gravity would not work--this is per the MD's orders.

Sonia,RN

Has 8 years experience.

I have always used the syringe and plunger and have never had a problem, except in special cases where the Gtube already leaked around the site; then I would use gravity.

Now I wonder if I should ask the doctor to stipulate in her order that the bolus can be forced instead of given by gravity. There's been no discussion at our facility that I'm aware of regarding force being subject to state citation.

RedhairedNurse, BSN, RN

Specializes in Med Surg, Ortho.

I'm confused. I have a patient with a tube that is referred to by fellow nurses as peg tube or j tube, depending on who's talking. I'm not sure exactly what kind of tube it is.

Whatever it is, if I don't use a syringe to force a bolus of Gatorade down that tube, nothing's going down that tube. Gravity will not suffice, and no matter how carefully I give that bolus, some will overflow out of this tiny tube, anyway. (I believe it's a Kelly surgical tube.) The doctor's order stipulates that we are to flush the tube with 30 mL of free water before and after drugs or any bolus. It does not, however, say how those liquids are to be administered. All of the nurses use the syringe to push.

So is it incorrect to use the syringe in this manner?

Maybe it's not going in because the patient has too much residual.

Are you checking for residual before you force anything?

I always let flow by gravity, if it will. I feel like I'll cause my patient

to have gas if I use the syringe. I always check residual, then unhook the

syringe from peg, remove plunger, replace syringe to peg.

There's no residual. This particular tube (Kelly?) is tiny compared to the tubes I work with on other patients. The cath tip barely fits into the top of the tube, and instead of having a stopcock to block flow, it has only a small stopper at the tip. Most of the time the patient is on Jevity at 70 mL/hr, except for the periods when the feed is stopped to allow the bolus of Gatorade and free water. The bolus is 500 mL, and it's administered by 60 mL syringe, so it can be rather time-consuming to stand there, force it, and then have to clean and change the patient after the Gatorade spills. As a newbie I wondered if it would be possible to give the Gatorade by feeding pump, but the patient isn't off the pump long enough for us to do that. She receives four boluses a day.

gambutrol

Specializes in SICU, Burn Unit, PACU, CCU.

peg tubes are usually standard size here in the hospital where I work. Newly created peg tubes are easier to work with because there's no degree of blockage that you would encounter. Here in our institution we only do the feeding via gravity (drip or bolus depends on the order) and it's a standard protocol to flush 60 cc of water afterwards. Checking for residuals is also a protocol to know if the patient has tolerated previous feeding.

Besides sitting in Fowler's to prevent aspiration, I have seen repositioning to the left or right just a little bit help with tube feeds - sometimes the tube is compressed by internal organs, I'm assuming.

evilolive, BSN, RN

Specializes in Cardiac/Step-Down, MedSurg, LTC. Has 6 years experience.

I have two PEG residents at my facility. One has just a 450ml flush per shift, she is on a continuous feed during my shift. Another resident is also on a continuous feed throughout 11-7am. I usually find that the 'flushes' go down fairly easily. The second resident I have has three 500ml flushes per shift (diabetes insipidus) with meds each time. If I were to flush with 30cc before administration, the 30cc would be gone by gravity by the time I grabbed my plunger! I've never had a resident become nauseous or vomit from slowly pumping fluid down the piston syringe. I used to use this method when my GT residents only had Foley caths in ... now they that they have the PEG tubes life is a breeze! Gravity gets it all down for me. I very rarely have blockages, but this is probably because the feed is going all during my shift. I'm not sure how things go for day shift.

RedhairedNurse, BSN, RN

Specializes in Med Surg, Ortho.

Besides sitting in Fowler's to prevent aspiration, I have seen repositioning to the left or right just a little bit help with tube feeds - sometimes the tube is compressed by internal organs, I'm assuming.

Yeah, I place my pts slightly on their left side because of the position of the fundus

of the stomach. It definitely makes it easier going in that way.

Magsulfate, BSN, RN

Specializes in ICU. Has 13 years experience.

I have always used the syringe but pushed very very slowly. A lot of the time there needs that tiny little extra push to get the medication down.

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