Gtube Feedings Help please!!

[RegenerativeNurse, ASN, LPN, RN]

K so I've got a peds case which requires me to feed them via gtube and administer their medications via gtube as well.

Now my main concern is I've not worked with Peds too much except during my clinicals and even then I never had a pt with a Gtube.

I just want to know exactly how I should go about doing these procedures with a child that is 1yr 7mos.

Is the flush amount for meds for more or less (than 15mL before and 30mL after)?

Is the flush amount between meds more or less (than 5mL)?

How much should, if I should, should I flush prior to feedings?

I'm a bit nervous and would like to know how experienced Ped nurses go about doing these procedures instead of reading a book about it.

[cayenne06, MSN, CNM]

My biggest advice is just to relax- g tubes are very easy to manage, and administering meds through them is no big deal. Your MAR should specify flush amounts- at least mine did when I did home care. If not, you need to consider your kid's age, other medical conditions and the type of med being administered. Some kids cannot handle large volumes bolused through their tube, so flushes sometimes need to be tailored to reflect this. Also, don't be afraid to ask the other nurses who care for this child. However, do NOT simply follow what they say if it is not explicitly spelled out in the MAR. Don't hesitate to call the kid's MD for clarification. It is always better to ask than to do a procedure you are not 100% confident in. The MD will happily clarify the order.

You will do fine! Just don't forget to close the med port when you are done, or you will end up administering a feed all over their bed- ask me how I know. :/

[KelRN215, BSN, RN]

Routine G-tube flushes (after meds/feeds) in children are about 5 mL. No 30 mL flushes for toddlers unless they're specifically ordered. I don't flush anyone's G-tube between meds (I don't drink a sip of water between my meds and I don't see the need for all this flushing, the meds are all ending up in the stomach) nor do I flush before meds or feeds (unless there seems to be an issue). Ask the parents what they do for flushing.

[RegenerativeNurse, ASN, LPN, RN]

Thank you guys!

Reading your replies alleviated my anxiety. What I already knew was actually correct! For a change. I'm still new nursing (kind of a recent graduate).

I haven't gotten to see the MAR yet and I actually won't get a walk through from anyone, I just 'start' this Saturday which is a little nerve racking. I know I need to get my nerves together bc I can't let the parents know I'm nervous or it'll be train wreck.

My patient is just terribly sick! Shaken baby syndrome sick! Traumatic everything. Smh

But I know I got this. I can do it. My confidence is growing!

[JustBeachyNurse, LPN]

Flushes are patient specific. When my patient was that young. The orders were 8ml pre/ post feed & 4ml pre/ post meds (not between each med). I've never seen a young pedi (under age 3) with 30ml or more for flushes

Again each patient I have worked with in the home environment had specific orders. The infants and toddlers are usually. 3-5ml flushes but again each had individualized physician orders.

[brithoover]

I don't flush pre meds or feeds and don't flush in between meds. Usually use about ml post

[RegenerativeNurse, ASN, LPN, RN]

Flushes are patient specific. When my patient was that young. The orders were 8ml pre/ post feed & 4ml pre/ post meds (not between each med). I've never seen a young pedi (under age 3) with 30ml or more for flushes Again each patient I have worked with in the home environment had specific orders. The infants and toddlers are usually. 3-5ml flushes but again each had individualized physician orders.

She's being monitored for increasing ICP which is why I didn't want to pump way too much fluid into her.

[Esme12, ASN, BSN, RN]

You need to be very careful of free water (flushes) with an elevated ICP and in the Pedi population in general

Brain volume is regulated by equal osmolality of extracellular and intracellular fluid. When extracellular osmolality decreases, water influx occurs in the brain resulting in cerebral edema. Cerebral edema will occur which will elevate the ICP even more....causing symptoms such as headache, nausea, vomiting, irritability, seizures, and even death

Remember the pedi population has a very narrow window for error. Small mistakes have huge consequences.

[JustBeachyNurse, LPN]

You should have very specific fluid orders for any pedi patient. My patient (under age 3) had ICP issues and we did not have pre-med or feed flushes, no between med flushes. Prior to having a G button flushes were 5mL post med and 8mL post feed to endure no meds or formula were left in the extension tubing. (The extension tubing was approx 5mL). Once switched to GB flushes were reduced to 3mL and 5mL. We also had a daily fluid goal that had to be met through a combination of feeds, meds & flushes. This sounds like a private duty pediatrics case (there is a private duty specialty forum here on AN). The care plan/485 should have specific orders for fluids and flushes. With pedi patients, especially complex pedi, each child is unique and their orders are specific. I had two patients. Both former NICU preemie patients. Both with g-buttons. Both with specific fluid requirements but different reasons. (One had renal & renal hypertension as well as malabsorption issues, patient 2 had GI motility, neuro and ICP issues). Their enteral formulas and feed orders (rate & volumes) could not be more different. Their calorie counts were similar If this is a home care private duty case (shift work) consult with the clinical supervisor if the 485/care plan is not clear. Children are stable until they are not. Children are not mini adults and this is often the biggest learning area for nurses transferring from adults and even adolescent care to young child home/private duty care. Adults have more reserves.

[JustBeachyNurse, LPN]

If you are an inexperienced new grad you should not be going to such a medically complex case without formal orientation with an experienced preceptor if not the clinical nurse manager responsible for the case.

Even as an experienced private duty pediatric nurse my second agency required not only company orientation, demonstration of clinical skills competency but also my first case was 8 hours with an experienced nurse preceptor.

All cases new to me I review the 485/care plan with the case clinical nurse manager and ask any questions not specified whether flushes, free water, restrictions, parameters to hold or delay a food or medication and any incidentals specific to the case/client/family.

You really need to seek clarification from your clinical nurse manager as this baby has been through enough risk & tragedy.

[Esme12, ASN, BSN, RN]

thread moved for best response

[Esme12, ASN, BSN, RN]

She's being monitored for increasing ICP which is why I didn't want to pump way too much fluid into her.

Do you get an orientation for this case through your agency? you should for this complex patient