G-tube Flush

[stkn1]

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!

[Freedom42]

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]

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.

[nminodob]

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]

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]

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]

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.

[Freedom42]

Newbie question: My patient requires multiple 500 mL flushes with Gatorade and free water on every shift. As mentioned, we force it with a 60 mL cath tip syringe. Is there any reason this couldn't be done with a feeding pump? It would be more time-efficient and more comfortable for the patient. We disconnect her Jevity feed at 0600, so we could theoretically replace that with boluses of Gatorade periodically.

[whipping girl in 07, RN]

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?

By what you've described, this tube sounds like a J-tube. I'm trying to figure out why you would give Gatorade into someone's small bowel, though. Generally you should only give tube feeding and medications through the J-tube. You cannot give bolus tube feeds into a J-tube because the patient will dump (cramps, chills, possibly a drop in BP and then explosive diarrhea). It's difficult to give tube feedings, meds or water by gravity through a J-tube, usually you would need to use a syringe with the plunger to push the meds and water in and a pump to give the tube feeding.

You should always flush any feeding tube with water before and after medications and tube feedings to keep it from clogging, whether it's a G or J or a nasal feeding tube placed in the stomach or small bowel.

When I teach home patients how to administer G-tube feedings, I show them the syringe gravity method without a plunger but using a syringe with the plunger and injecting the feeds, meds and water is acceptable too, although sometimes it can be uncomfortable.

I've never heard of the state citing a facility for giving tube feeds with a syringe but then I work in a hospital and most of our tube fed patients have nasal feeding access and we use pumps.

[Skeetersmom119]

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.

I have found that cranberry juice is another good liquid to put through the tube to help unclog it. Also, diet gingerale works well. It is also helpful if the preceding nurse flushes the tube properly. When that happens, I have no problem with clogging, even at the low infusion rates.

[rachelgeorgina]

I work in a facility where over 50% of the patients (disabled children) are gastrostomy fed. If feeds are bolus, then we add water following the feed and let it run through by gravity. We try to avoid using syringes with the bolus feeds and flushes because of the risk of pushing air through (and giving the kids gas.) If the feed is via a pump, we flush via the pump too, by adding water to the bag when the feed is finished and sending it through via the pump.

Meds are flushed with smaller syringes with roughly 20mL water (often that fit straight into the button, for kids that have buttons that don't need their tube attached for medication administration.) We flush before and after each medication.

[K+MgSO4, BSN]

I am slightly confused is the OP discussing various types of surgically inserted gastro tubes or also talking about a NASO GASTRIC tube?? I have flushed PEGS etc with a syringe and plunger slowly but never an NG. The pt with an NG should be in the high Fowelers postion which will help with gravity.