Tube feeders-vomiting,diarrhea,aspiration

nursedawn67, LPN · Dec 22, 2004

I work in LTC and it seems like our G-tube feeders are frequently congested, having diarrhea and having vomiting episodes. We report these things to the doctors but they don't do anything about it except order antibiotics. How is it at your facility? What should we do to stop the vomiting, diarrhea and aspiration episodes? Thanks :)

I guess I would first be sure everyone is doing the obvious...head up, checking for tube placement and residual, and is the rate and amount of feeding too much for that resident. After that maybe check to see if they have an intolerance to that particular formula, are they also taking oral intake, if so maybe they are getting too much in during the entire day ( I have a resident that I have seen this as the case).

CoffeeRTC, BSN, RN · Dec 22, 2004

Biggest thing to watch...HOB up. When CNAs are doing care are they turning off the pump or putting it on hold? Checking placement even with g tubes. Getting them OOB everyday to sit up in chairs. As far as N/V/D..might need a formula change..something with more fiber. We use a lot of fibersource HN, or Diabatic Resourse. Maybe look into down times and flushes. If they are getting Po intake...maybe speech needs to re evaluate swallowing.

Blackcat99 · Dec 23, 2004

Thanks so much for your very helpful information. :) I was told that you only need to check placement with NG tubes not GT Tubes. How exactly does one check for GT placement and residual?

CoffeeRTC, BSN, RN · Dec 23, 2004

Most G tubes stay in place. Still will check with air, esp if they are frequent transfers or if the tube isn't used much. As far as residual we only do this on new tubes. Just pull back on the syringe and note amt of any. Then re insert.

With NG tubes (rarely see these any more since most will come with the Gtube) I am hyper vigilant with checking placement.

redshiloh · Dec 23, 2004

Check residuals. If they are over 1.5 times the infusion rate, feedings should be held for an hour and rechecked, then if the residual decreases, restart. It is possible in the elderly to have ileus, gastroparesis that can lead to regurge,vomiting which can also lead to aspiration.

Blackcat99 · Dec 24, 2004

Thanks again :) . I just made out my health directive and it specifically says "No tube feedings. I just feel so sorry for the lady who is always nauseated and always having diarrhea. It's so true when they say there is a fate worse than death. :crying2:

Home Health Columnist / Guide · Dec 24, 2004

google helped compile this info:

check gastric residual before each gt feeding or as ordered for continuous feedings. hold feeding prn for high residuals (> 1/4 of feeding amount) or as ordered.

http://home.texoma.net/~sferrer/careplan5.htm

patient ed + pictures

http://patienteducation.upmc.com/pdf/gastrotubefeed.pdf

gastrostomy tube (g-tube) home care

http://www.cincinnatichildrens.org/health/info/abdomen/home/g-tube-care.htm

flow diagram:

management of a child whose gastrostomy tube or button has been dislodged

http://www.starship.org.nz/docs/gastrostomy.pdf

tube feeding in the elderly

the technique, complications, and outcome

http://www.postgradmed.com/issues/2004/02_04/dharmarajan.htm

mechanical complications in long-term feeding tubes

http://nsweb.nursingspectrum.com/ce/ce201.htm

Blackcat99 · Dec 25, 2004

Thanks so much NRSKarenRN. I found all of those sites you listed to have such great information!

TracyB,RN, RN · Dec 25, 2004

Awesome sight referrals NRSKaren....

I wanted to ditto the obvious, such as HOB ^, feeding on hold, while pt being turned for cares..... ALWAYS check residual...If patient has a peg tube, they are usually in place, but I still like to check placement by listening at sight with 5-10 cc air bolus, then I let the tube vent (like burping it).

At a previous facility, when our feedings changed, the pts often would end up with N/V/D... probably needs a new formula, along with the basics of GT feeds, head up!!!!!!

mitchsmom · Dec 25, 2004

you may have already considered these... is the formula at the right temp, not too cold? It may also be lessened with diluted feedings, a different product, or slower infusion?

sis14rn · Dec 28, 2004

Are your tube feeders dumping? I think you need to get your dietitian involved, maybe it's the feeding. How are the nurses giving meds via the tube? Is it drug interaction? Are you keeping the HOB up? Putting them on ABX could be increasing your vomiting and diarrhea. Hope this helps :) :)