G-tube insertion

[cnnconstance]

I am a resent graduate LPN and last night at work resident pulled his g-tube out. I felt totally inept and incompetent when my charge RN stated " I can't believe you have been here for two months and you haven't done this yet? I am not sure if this is in my scope of practice. It was never in a skill check off for second semester. Can anyone tell me? It really was not difficult, in fact , the resident did it again later in the day and I reinserted it myself. I know that this is my responsibility to know my scope and the skills that I am allowed to do. I need a little clarification. Thanks for any input.

[Tait, MSN, RN]

Interested in the responses. I guess it depends on the G-Tube. Most of the ones we have in the hospital are surgically sutured so if they come out, it's too bad and has to wait for an MD. I did have a patient who had one that was like a foley and his mom would just get a new one and reinsert it. She did this quickly because she said otherwise the hole would close up.

[melmarie23, MSN, RN]

all the G tubes and PEG tubes I have come across recently (and I too am 2ish months into my first RN position) have been sutured in place. If they came out, we'd have to inform the MD and they replace it.

[CT Pixie, BSN, RN]

All my G-tube residents(as well as all the G-Tube residents on the other units in my facility) have had to have it placed back in surgically at the hospita should the tube become dislogged for whatever reasonl. To be honest, had no idea there was any other way than surgically sutured.

[cnnconstance]

I found a web site that has the exact tube that we are using. It really is a matter of is this an RN delegated task or is this iwithin my scope of practice. I was never taught it in school. We had trach and nasograstric, but this was really my first time getting training.

http://www.thermofisher.com.au/Uploads/file/Healthcare/Medical-Devices-Consumables/Critical-Care/Gastrostomy-Tubes/Balloon-Gastrostomy-Tubes-viasys.pdf

[CT Pixie, BSN, RN]

I would say the only correct answer of whether or not this task is within your scope of practice would to contact your State's Board of Nursing.

[Tait, MSN, RN]

I found a web site that has the exact tube that we are using. It really is a matter of is this an RN delegated task or is this iwithin my scope of practice. I was never taught it in school. We had trach and nasograstric, but this was really my first time getting training.

http://www.thermofisher.com.au/Uploads/file/Healthcare/Medical-Devices-Consumables/Critical-Care/Gastrostomy-Tubes/Balloon-Gastrostomy-Tubes-viasys.pdf

That looks like the kind we use in the hospital and we can not put them back in. They are surgical for us. I would talk to your manager and find out the policy/training.

[caliotter3]

When I worked in LTC, one was malfunctioning on one of my residents. Another LVN who had been there for years told me that although the nurses routinely replaced the tubes there, she was of the opinion that it had to be done by a doctor because she used to work in a doctor's office and people were brought in to have the doctor do it. Later, I was told that the doctor does the surgically sutured ones, and nurses do the ones that have been in place a long, long time, are not sutured, and are changed at routine intervals or when malfunctioning. I have done this in the home environment many times. The plan of care will have an order for the nurse or trained patient care giver to change the tube. I recently had a patient with a PEG that needed to be changed at the hospital. Mom discussed this with me. Always look for a valid order for the nurse to change the tube.

[txspadequeenRN, BSN, RN]

i have replaced many g tubes in my career as a nurse (lvn and rn). if i am not mistaken the texas bon says it must be a rn now (not exactly sure if a lvn with proper training can re-insert) . i do know this something has to be inserted in the site or it will close up and usually that is a foley cath. this is in ltc though....i work in a hospital now and that practice is a no-no. im sure if we had a g tube fall out in my hospital now and there was no doc available to reinsert and i said ...well ok where is the foleys....my charge nurses would fall out....

[Fngrpntsnotasin]

Check your orders. We have orders that go may change 18 fr gt with 5 cc balloon prn. Pegs cant be replaced in facility, they have to go out. I had a resident the other day who had to send out for a gt replacement due to the fact that i found it out during am med pass and didnt know how long it had been out...tried to replace and couldnt get it. When they come out you have to get them back in asap. Dont forget to check placement after reinsertion

[cnnconstance]

Thank you for all the replies. I asked about facility policy and we are allowed to replace it with the foley insertion kit. As long as we insert it immediately and check placement these are the physicians orders.