G-tube pulled out by patient

Specialties Rehabilitation

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Im a new nurse who got hired 3 weeks ago at a rehab/acute care. I had one patient who pulled out his G-tube. It happened so fast. At 9pm, I have just given her her PRN pain med and she was fine. At 1030pm, the CNA just check on her and she was still fine. When I checked on him at 11pm, it was all out. I immediately called the other nurse whom I am working with. I am so worried that they will kick me out of the rehab because of what happened. =(

What I did was cover it with wet sterile dressing and notified the MD. He told me to send him to the ER. Can an LVN insert a g-tube?

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Can an LVN insert a g-tube?
Whether you can do this (or not) depends on the policies and procedures at your place of employment. The best person to ask would be your DON or nurse manager at your workplace.

However, when I was an LVN in rehab, I always inserted a Foley into the stoma after a patient pulled it out to prevent closure of the stoma. I didn't care if it was against policy as long as the patient's G-tube stoma remained open.

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I haven't asked about the facilites policy regarding g-tube, but there was no standing order to re-insert it in case it gets to be pulled out.

As a new nurse, and this thing happened on the very first time that I am on my own, I felt like it was my fault and that I did something wrong.=(

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Specializes in HH, Peds, Rehab, Clinical.

That's nothing. Wait til you find your first PICC line laying on the floor....

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I felt like it was my fault and that I did something wrong.=(
Since my conscience is not terribly active, I generally do not blame myself for things that go wrong in the workplace. Guilt is not a part of my emotional repertoire, and it is less stressful living this way.
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Specializes in Critical Care.

You just reminded me of my event.

Patient was fine. 30 minutes later he is freaking out up from his chair (the man is easily 6'2",.. I am 5'6") I walk in to see him standing.. the recliner is down and kinking/pulling his cheat tube and his picc is completely out sprawled on the floor.

My attempt to de-escalate the situation resulted in me being pushed slightly by the patient as he grabs his chest tube chamber out of my hand and off he goes down the hall in his little gown. He made it pass 8 rooms or so before turning sheet white and needing to sit in a chair.. Guess he needed that oxygen he left in the room.

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Specializes in CNS Pediatric Surgery, now retired.
Where I worked w/ g-tubes, we used the corresponding size foley as the temporary solution.

Just curious, what is the best way to secure an in and out foley used as a temporary g-tube stoma-opener?

1. Before you insert the Foley: Cut a slit in the top of a baby nipple and thread the Foley through the nipple so the base of the nipple will end up against the patient's skin. Insert the Foley. Pull the Foley catheter up so the balloon is securely against the wall of the stomach. Slide the nipple down so it is against the patient's skin. Wrap cloth adhesive tape around and around the Foley just above the nipple. You need the tape to be too fat to slide through the slit in the nipple. You can cut a slit in a 4x4 and slide it under the nipple against the patient's skin.

OR

2. If the Foley has already been inserted and you forgot the nipple: Pull the Foley catheter up so the balloon is securely against the wall of the stomach. Then wrap cloth adhesive tape around and around the catheter close to the skin. You want to make a wad too big to go into the opening.

Both techniques eliminate having to put any adhesive on the patient's skin. (We did this for years before they invented Buttons, MIC-KEYs, etc.)

We would teach the parent/caregiver of our pediatric patients how to insert a Foley if their G-tube came out. Those stomas can close quickly and some of our patients lived a great distance away.

I had one patient whose stoma had closed down so much we could only get a 5 Fr feeding tube through the opening. The patient was going to be hospitalized anyway for their medical problem so each day we dilated the opening a little more and moved to a larger tube. It took 5 days to get back to their original size but at least we saved them a trip to the OR.

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Specializes in CNS Pediatric Surgery, now retired.
This was very unnerving for me the first time one of my patient's pulled out his g-tube. He was twirling it around and smiling at me when I walked in the room.

I had a 4 year old patient with a long-term gastrostomy. He would look for a new nurse or nervous-looking parent and whip out his G tube and wave it at them. He would stand there giggling with Pediasure oozing out the stoma. When another nurse responded to the inevitable shriek, she would just point to the treatment room. He would trot off to the treatment room, giggling the whole way. Every nurse on the floor got to practice inserting a G tube.

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Specializes in Registered Nurse.
You just reminded me of my event.

Patient was fine. 30 minutes later he is freaking out up from his chair (the man is easily 6'2",.. I am 5'6") I walk in to see him standing.. the recliner is down and kinking/pulling his cheat tube and his picc is completely out sprawled on the floor.

My attempt to de-escalate the situation resulted in me being pushed slightly by the patient as he grabs his chest tube chamber out of my hand and off he goes down the hall in his little gown. He made it pass 8 rooms or so before turning sheet white and needing to sit in a chair.. Guess he needed that oxygen he left in the room.

OMG...is it wrong that I found this to be sooooo funny?....I was almost in tears laughing out loud. I was picturing this person holding the chest tube chamber like a football! Haven't laughed like that about a nursing story in a while!!

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Specializes in PICU.

I agree, don't worry too much about this. Patients pull stuff out. In less than an hour from the start of my first shift on my own in the PICU my patient pulled his EVD (external ventricular drain) out. The neurosurgeon was not happy when I called him!

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Specializes in Pedi.
That's nothing. Wait til you find your first PICC line laying on the floor....

Babies tend to pull them out and then wave them around like a lasso.

I'm trying to remember if I've ever had a patient with a G or NG tube who didn't pull it out at one point. Kids tend to do those things. If the tube is a MIC or a MIC-Key, those are easily replaced. If it's a PEG (which, in theory, should be more difficult to pull out), place a Foley in the stoma to keep it open.

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Specializes in Complex pedi to LTC/SA & now a manager.

I had a patient that would yank his GB out while a feed was running and laugh hysterically. Why? Because he loved the fart noise it made after he yanked it out. I transferred the chosen behavior to a whoopie cushion I bought. The stoma was getting granulation and irritation. To determine it was the preferred noise or sensation,I walked around making raspberries to redirect.

Such a boy loving fart noises and torturing nurses.

Yesterday one pulled his relatively new trach out, fortunately I've been tortured enough by little boys to have my mental check list memorized and replaced the trach quickly & efficiently without issue. He pretended to sleep complete with imp grin and fluttering lashes when my manager came to assess.

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