G tube. Help.

iggywench, BSN, RN · Mar 21, 2016

I have a student who gets water via G-tube twice a day, and does feedings at home. I would ask for doctor's orders, make sure that mom provides all supplies needed, and that you receive training on that specific student. Either have mom walk you through the procedure, or a nurse from your district. My student's mom doesn't speak English, and the student isn't assertive enough to guide me, so the lead Special Ed nurse from our district came and helped me until I felt comfortable. I also have my aide trained to do the procedure; I hope there is someone at your school who you can train to be your back-up. Feel free to contact me if you have more questions.

OldDude · Mar 21, 2016

As Iggy mentioned above, get the standard md orders and include "administration by school personnel." I do the opposite as Iggy. I train an aide to do the feeding and I am the back up. Also, I don't do tube feedings in my clinic but find some private location out of the flying infections of the clinic environment. Be sure and get a MD order for intervention if the g-tube comes out at school - whether to reinsert it and tape over or not reinsert, be sure to include a MD order will be required to restart feedings if the g-tube comes out - a parent note will not suffice. I have a care plan and training checklist if you want.

Cattz, ADN · Mar 21, 2016

I have a student who gets water via G-tube twice a day, and does feedings at home. I would ask for doctor's orders, make sure that mom provides all supplies needed, and that you receive training on that specific student. Either have mom walk you through the procedure, or a nurse from your district. My student's mom doesn't speak English, and the student isn't assertive enough to guide me, so the lead Special Ed nurse from our district came and helped me until I felt comfortable. I also have my aide trained to do the procedure; I hope there is someone at your school who you can train to be your back-up. Feel free to contact me if you have more questions.

Thanks iggy :)

GdBSN, RN · Mar 21, 2016

Yes, make sure you have Dr's orders that state amount fluid and flush amount, and the orders should also state the procedure if the tube becomes dislodged or if fluids are unable to flow. Make sure you have an emergency plan for if the tube becomes dislodged, and be sure all the teachers that have that student understand the emergency plan (and tell them there is no reason to panic). In our district, parents furnish tubing and syringe supplies, and the district supplies the liquid. Check with your district to find out who can administer the feedings if you are not on campus. Just this year, we were able to train unlicensed personnel for feedings.

Cattz, ADN · Mar 21, 2016

As Iggy mentioned above, get the standard md orders and include "administration by school personnel." I do the opposite as Iggy. I train an aide to do the feeding and I am the back up. Also, I don't do tube feedings in my clinic but find some private location out of the flying infections of the clinic environment. Be sure and get a MD order for intervention if the g-tube comes out at school - whether to reinsert it and tape over or not reinsert, be sure to include a MD order will be required to restart feedings if the g-tube comes out - a parent note will not suffice. I have a care plan and training checklist if you want.

Thanks OldDude. I think I may have this info. I hate to ask you to go to the trouble to get it to me right now. It sounds like I have a few days to get my paperwork in order. If I can't find the care plan and training checklist. I will give you a holler back.

Cattz, ADN · Mar 21, 2016

It sounds like this is a very disorganized family situation. Moving here from another state. My gut tells me to have to mom go ahead and get a local dr. and have her to get my orders for school from the local dr. As of now, the dr is several hours away.

Maybe I am over-thinking this. Any thoughts?

OldDude · Mar 21, 2016

It sounds like this is a very disorganized family situation. Moving here from another state. My gut tells me to have to mom go ahead and get a local dr. and have her to get my orders for school from the local dr. As of now, the dr is several hours away.
Maybe I am over-thinking this. Any thoughts?

I think that would be an excellent idea if it could work but it is unlikely it'll happen before school enrollment. Since this is an ADL for this child and mom she is probably not gonna be as enthusiastic about getting new MD orders as you are. It's more likely you'll be lucky to get "any" MD orders at enrollment; I know, cynical me.

GdBSN, RN · Mar 21, 2016

Check with your district, and let Mom know that without current MD orders you are unable to administer feedings, and that she will have to come to school and do it. Maybe that will light a fire under her to get orders.

Flare, ASN, BSN · Mar 21, 2016

Oh, I am again in agreement with my esteemed colleagues. I would'nt be touching the gtube without having a current md order. Granted, I may not necessarily require a local dr, per se. A copy of the old order from the old school may suffice as long as it was current to the school year. As long as everything is in order I'd probably be ok with it. Now - since you don't know the family, i'd get on the horn and reach out to the old school's nurse and find out if there is anything special you need to know (like you need to hound the family for supplies or maybe that they are on the ball and will bring you supplies in a week before you need them; that the child tends to vomit after feedings; that the child tends to forget to come and needs to be reminded; whatever) I know if i were to get a call, I'd be happy to give a mini report.

Kitiger, RN · Mar 22, 2016

Be sure your order includes how much water to put in the balloon.

As a private duty nurse working with vent kids, I go to school with some of my kids. The Go Bag always has a spare GT, obturator if needed, Luer syringe, and spare dressing & tape. A foley cath will work to keep the stoma open PRN. I had one child whose GT broke: the Luer adapter broke off ...