peg/gtube question

[spunky1281]

I had a LTC resident pull out his Mic-key gtube. I am an LPN and have never been trained to deal with them coming out. The charge nurse was an RN. If a resident pulls it out, do they get sent in to the hospital or can a nurse reinsert it? I brought it to the charge nurses attn and he made the call to reinsert it himself, only for 1 hr and 15 min later for the resident to the whole kitten caboodle out again. I was iffy on putting it back in since he was able to pull it out with a inflated balloon. What is protocol for this?

[noahsmama]

I assume each facility would have their own protocol for this. At my facility (pediatric hospital) it was recently decided that RNs could reinsert/replace G-tubes after we had one case of a pt pulling hers out and another pt whose mom wanted his GT replaced because it was getting old and worn out. We were all trained to do it, it's pretty simple -- just insert into the stoma and inflate the balloon. However, if I ever have to do this (hasn't happened yet), I will also notify the MD just to let them know. Also, if pt is pulling it out repeatedly, MD should know because if they're pulling it out balloon and all this could cause some damage or make the stoma larger.

I don't know if this is something an LPN can do because we don't employ LPNs at our facility -- and again, it's likely to be facility-specific.

I hope that helps!

[FLArn]

Sometime ago in FL, it was decided that nurses would NOT reinsert Gtubes/PEG tubes as there is no definitive way to verify placement in the nursing home. Also I believe there was a case of a patient developing sepsis after a tube was misplaced and feeding was instilled in the abdomen.

[vashtee, RN]

i believe we are just supposed to stick something in to prevent the hole from closing, but not the actual tube... grr! I remember hearing about it, but the memory escapes me now.

[Sparrowhawk]

Okay how exactly can you put a G-tube in anywhere else but the stomach?? In our facility the nurses can do it..and we do.

[FLArn]

The stoma (opening -wound) in the skin and abdominal muscle stays patent (open) for quite a while. However the opening in the actual stomach wall closes VERY quickly even in older Gtube sites; thus it is very easy to think you are in the actual stomach when really you are in the peritoneum.

[kcochrane]

In my facility, your simple balloon peg tube can be replaced by a RN or LPN, if this in not the first one the resident has had AND if the nurse has been trained to do it. Usually the dr. will write a non-med order stating such if it can be done by a nurse.

[saintplatypus]

I worked in a small LTC with about 65 residents with over half of them being GT pts. In the case of mic-key or other tube we replaced them ourselves if they came out and then checked placement per air bolus. Never had any problems with this. But the facility I work at now does not allow any nurse to replace they must be sent to the hospital for that. So I guess check your facility's policy because all places are different.

[kids]

We change them here and verify placement like any other feeding tube before use - aspirate gastric contents and auscultate an air bolus.

[DLS_PMHNP, MSN, RN, NP]

At our hospital, G-tubes can be replaced by RNs/LPNs. However, J (jejunal)-tubes are replaced by radiology.

[rachelgeorgina]

Nurses of any level cannot replace a G-tube where I work nor a J-tube, though I'm sure if it came to it, a nurse could drop an NG.