G-tube Flush

  1. 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!
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    About stkn1

    Joined: Mar '06; Posts: 2

    22 Comments

  3. by   Ms.RN
    We use a kangaroo syringe when flushing peg tube with water or giving medicine. I was told never to use syringe plunger to inject water or medication becuase if its injected too fast patient it will cause nause and patient can vomit and I've seen it. When the state surveyors are watching giving meds via peg tube, we are always to let it flow in by gravity, never use plunger which is frustrating when water wont flush when mixture of medication clogs the peg tube and it wont flush. But if we use plunger to inject anything into a peg tube we will be sited by the state. :redlight::redlight::redlight:
    We flush peg tube with bolus of water. The order states to flush peg tube with 200cc of water q shift, and we pour 200cc of water.
    Last edit by Ms.RN on May 26, '09
  4. by   gt4everpn
    Yes from what I've learned it is to be flushed by gravity esp when the state is there.. To be very honest I have 40 patients plus about 10 peg feeders and other things to do and I usually bolus or inject it because often it doesnt flow fast enough by gravity plus it prevents clogging. I have never had a patient aspirate or vomit when I inject it.. but I do realize that it may cause aspiration pnuemonia.
  5. by   tothepointeLVN
    I'm still new to nursing but I pull up with a plunger but then let it go by gravity but if it gets stuck then you already have the plunger in place. I have tiny hand shakes and splash water everywhere without the plunger in place. This was the way one instructor taought me but they are all different
  6. by   CITCAT
    In reply to the question of flush or not to flush flush is a flush piston syringe toclear to tube with warm water the patient has to be forty degrees up or they will aspirate, in regard to admin meds bolus meds one at a time that is the proper way to do it in my region Any takers?
  7. by   Pepper The Cat
    I always use a syringe. I believe you need the extra "push" to make sure meds don't adhere to the sides and cause blockage. I also always use at least 100 cc of water, to make sure the g-tube is clear. I've never had a pt vomit while I did this. I have encountered block g-tubes because the nurse before did not flush it well after meds.
  8. by   Freedom42
    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?
  9. by   SunnyAndrsn
    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.
  10. by   SunnyAndrsn
    Quote from Freedom42
    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?
    My other pt. has a G-J tube, with one port in his stomach, the other in the jejunum. I use syringes to push his medications, as gravity would not work--this is per the MD's orders.
  11. by   Sonia,RN
    I have always used the syringe and plunger and have never had a problem, except in special cases where the Gtube already leaked around the site; then I would use gravity.
  12. by   Freedom42
    Now I wonder if I should ask the doctor to stipulate in her order that the bolus can be forced instead of given by gravity. There's been no discussion at our facility that I'm aware of regarding force being subject to state citation.
  13. by   RedhairedNurse
    Quote from Freedom42
    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?
    Maybe it's not going in because the patient has too much residual.

    Are you checking for residual before you force anything?

    I always let flow by gravity, if it will. I feel like I'll cause my patient
    to have gas if I use the syringe. I always check residual, then unhook the
    syringe from peg, remove plunger, replace syringe to peg.
  14. by   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.

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