Feeding Tube Problems - page 2
I work in a nursing home, LTC. I have a resident that has a peg tube. It continues to get clogged. We even sent her to the ER to have something done because no-one could flush it. When you try to... Read More
May 6, '09Occupation: RN LTC From: US ; Joined: Jan '03; Posts: 3,757; Likes: 1,820It has been ages since I've seen a clogged tube.
Def needs a tube change. How old is is? What does the tube look like? Push the family/ pt to get the tube changed.
The cranberry "juice" we get is more of a cran drink....very little acid.
May 6, '09Occupation: Interventional Radiology Nurse Specialty: medical/telemetry/IR ; From: US ; Joined: Mar '99; Posts: 281; Likes: 81how long has she had the tube?
I work in IR where we put the tubes in. The docs put I think a 12 or maybe its a 16 french in to start then they come back later-month? to upsize tube.
sounds like she needs tube change and a upsize.
couldn't you'll send her to your IR to evaluate tube? ER wouldnt really know what to do. at least ours doesn't they just send them to us.
Jul 31, '09Occupation: Student Joined: Apr '06; Posts: 83; Likes: 45We have sent this poor woman to the ER so many times. They send her back saying there is no doctor there to change the tube. This lady's family finally requested that the tube be taken out since she was eating. They took it out and found that 1., the tube was too small which is what we kept telling them, she was getting too much feeding, rate was too high with her eating too, and 2. there was a broken off q-tip in the tube causing a blockage! The lady has since been released to home without her feeding tube and is doing well. Thanks for your help. moo
Jul 31, '09Joined: Sep '03; Posts: 2,375; Likes: 2,862When I worked with chronic adults, we were allowed to use meat tenderizer for sluggish or clogged tubes. But I wouldn't use it if your facility's MD's aren't aware of it. It is supposed to gently "digest" the plugs which sounds like what your patient was vomiting up.
What your patient really needs is a new tube. The PEGS I used to work with were super simple. We could pop off the Y adapter, hold the tube at the base where it went into their skin, then gently strip the clogs away from the patient. Of course we couldn't strip the part inside the patient but, that usually worked. That, and once the "track" was healed, an MD could change the normal PEG tube out with a 20F Foley cath and they almost never clogged. But for those things you will need cooperation from the MD.
FWIW, one of my co-workers back then swore that only diet pepsi worked to unclog tubes. I don't know about that, but it was safer since so many of our patients tended to have high glucose levels.
One more thing. I forget the formula you mentioned the patient being on, but I think you added 1.5 to it, I guess indicating it's a 1.5cal/ml formula, but if you are flushing with 100mls of water every 2 hours, there is no point in giving concentrated (more than 1cal/ml) formula. The patient might as well be getting more standard 1cal/ml formula. Sorry for the "formula" references, been working with babies quite a while.
Jul 31, '09From: US ; Joined: Oct '01; Posts: 6,238; Likes: 1,829Try gently stripping, milking or rolling the tube between your fingers as you flush with warm water, feedings tend to build up on the inside of the tube (you can see it on the clearer tubes), if they come off in too much of a hurry they will plug the tube.
Consider switching to the the Kangaroo Entriflush (love it but is expensive) or the Kangaroo 524 pump.
The Bionix DeClogger is an inexpensive declogging option and can be used as a preventitive measure. http://www.bionix.com/pages/DecFeatures.html
(Personally I think it's a faster and more cost effective option over the others in the article posted below.)
This is a good article on the causes and management of tube clogs. http://rn.modernmedicine.com/rnweb/a....jsp?id=142656
My personal experience is that cocktailing meds -mixing them all together- is a huge part of the problem. Many nurses refuse to believe it ("they all mix together in the stomach anyway") and are resistive to the practice of administering meds one at a time and flushing in between. Just because multiple meds seem to mix well in a cup doesn't mean they don't inter-react with the formula residue that coats the inside of the tube. There is a reason why administering meds one at a time and flushing in between is the standard of care in many areas.
Jul 31, '09Occupation: . Specialty: . ; From: US ; Joined: Apr '09; Posts: 412; Likes: 188^^ I was going to mention the specialized declogging products! I work with children who have long term gastrostomy feeding tubes and I was going to suggest the following, though I'm almost 100% that you were covering these things -
- 2hrly flushes with water
- Flush between each medication
- Medication to go through the tube, NOT the button
- Medication to be exceptionally well crushed and liquidated before pushing
- Reassessing the density of the feed - perhaps changing to a more fluid/less thick feed and/or watering the feed down to ease the flow
- Venting the tube to relieve pressure in the stomach before feeds
- Regular water boluses
I'm curious - if the tube was removed because she was eating etc then why did it stay in for so long in the first place if she could maintain her weight and nutritional status without it?