GT continuous feeding with malfunctioning pump

[manda691]

AI'm a new grad RN who works as an RN supervisor at a 250 bed facility LTC with a 50 bed sub acute unit. I tend to have to use my judgment a lot because I work night shift on the weekends and I either have to ask an experienced LVN or try to google it unless I want to wake my boss up. This weekend I had a patient on a GT feeding that is 50 ml/he for 20 hours on at 12 noon off at 8 am. The feeding pump stopped working at 3 am and we had no extras in the building and we can't order a new one until 8 am when our supplier opens. I asked if we could give a bonus feeding and was told it was too much give via bbolud. I asked the experiences LVN who's worked there for 4 years what we could do and he said that they hang to gravity and only unclamp the tubing slightly. I wrote on the shift report what happened and that the feeding should be stopped at 8 am and was running to gravity I also endorsed this to the am RN supervisor. Unfortuantely the feeding was not stopped by the LVN at 8 am it ran to gravity until a pump was delivered at 330 pm. The patient received an extra 500 ml of feeding an we were unable to resume the feeding until much later because of high residuals. The morning RN says she never reminded the LVN about the feeding and never checked on it herself but that I am at fault because I hung the feeding to gravity. Obviously I'm glad the patient is unharmed because it could have been worse but I'm just wondering if I had this situation again what the correct solution is? Does the patient go without a feeding until the pump is delivered?

[JenERally]

It sounds like you gave report to the RN at the end of your shift at which time the pt became the RNs/LVNs responsibility. While hanging a feeding to gravity may not have been ideal, you did what you could with what you had. Had that RN and LVN properly assessed the pt following change of shift, they would've spotted the problem and addressed it. Hopefully you documented handing off to your charge and making her aware of the situation; regardless, even if you didn't document the specifics of your handoff, the nurses can't pin 7.5 hours of over feeding the pt on you.

[casi, ASN, RN]

Also that g-tube should have been checked WELL before 3:30pm. Especially if his tube feeding was to start at 12noon. What was that patient's nurses doing all shift and how was the patient getting their scheduled flushes and medications? Someone had to have noticed that feeding hanging.

I personally would have called an on-call for orders and given him the following options

1. Hold feeding until pump becomes available. Have RD eval if changes needed due to missing feeding

2. 250ml (remaining amount) bolus through the g-tube.

3. Hang to gravity. Make sure you mention if you are just giving slowly or if you can calculate a drip count for 50ml an hour.

I'd also make sure when I hung the feeding to gravity I'd only put 250ml in the bag.

[CapeCodMermaid, RN]

I had a nurse tell me once that G-tube feedings didn't work without a pump. I had to explain gravity to her. That said, I probably would have called the MD and ask to split the remaining feeding into several bolus feedings.

[NICU Guy, BSN, RN]

I am assuming that the bag is larger than 1000 mL. If it was 1000mL it would have run out at 8 am like it should have. You could have titrated gravity feed at 50 mL/hr and only had 250 mL in the bag. Otherwise, it is not your responsibility for the morning staff not to check on the patient for 7 1/2 hrs after you left. You could have called the doctor to do several bolus feeds, maybe five 50 mL boluses,

[carlacec]

I would've called the physician. Let it be their decision.

[amoLucia]

I had a nurse tell me once that G-tube feedings didn't work without a pump. I had to explain gravity to her. That said, I probably would have called the MD and ask to split the remaining feeding into several bolus feedings.

This most assuredly would have been my approach. At worst, you could have held the feeding for the last 5 hours or so. Fifty ml per hour for 5 hours would be 250 ml. Most formulas are 1 ml equals 1 calorie, so you're talking 250 cals. Not too terrible to be omitted for a short time, unless the pt were diabetic.

Personally, I would NOT have hung a gravity drip for the reasons that did occur. Also the risk for a runaway drip would be too much a risk for my liking.

I'd have called the MD with my options and let MD decide.