Gtube Feedings Help please!!

Specialties Private Duty

Published

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.

Specializes in Peds/outpatient FP,derm,allergy/private duty.

I wouldn't take a new case without orientation and a 485 either. It is not safe.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
They are hand written and not completely legible hence my confusion. I see only 100mL post feed, so I'll not be giving any more than that. I am awaiting the discharge papers which i hope are much clearer.

And i understand my being a recent graduate makes this risky business. I was hoping to get someone to walk me through at least halfway but I'll be the first nurse to care for the child once discharged.

Your identification that it is risky business, for you, concerns me...... for it is the childs life at stake here...not yours. You should run screaming from this agency who hires a new grad and doesn't ensure their competency to care for a complex fragile pedi patient.
I've had patients with some of these diagnoses such as seizure risks and ^ICP, just not in Peds. I'm comfortable with the treatment as well. Especially suctioning, I'm a wiz.
Peds it it's own specialty and in no way resembles adult care with the same diagnosis. What are the normal vital signs for this age? What are some of the common med dosages for this weight group? What size suction catheter should you use? What are the special considerations you need to take in suctioning an infant and why...What special considerations should you take in suctioning an infant with an elevated ICP and why?

I mean no offense..but you are in WAY over your head!!!! WAY OVER OUR HEAD! While you might be a whiz at suctioning....you clearly don't have the pediatric experience to know how to deal with a medically complex infant. You are way to cavalier about this....you should be very upset at the agency for thinking this is ok.

We cannot give you a crash course on how to care for this child...and certainly not when we haven't assessed the infant ourselves...but we all know to be afraid of this agency and afraid for you and your patient.

Your agency had you apply for a NPI which probably means you are an independent contractor and solely responsible for you actions....they will toss you on your ear and under the bus in a heart beat when something goes wrong...and it will. Please look into your own for I will lay very good money that the agency doesn't cover you at all as they consider you an independent contractor and responsible for your self....a cheap way to go for them.

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.

Kind of a new grad? May right?
Oct 22 by RegenerativeNurse

I graduated in May.

You just took NCLEX in August so this is your first nursing job. In September you were asking about
by RegenerativeNurse Sep 22

the title asks it all.

What exactly are these basic nursing concepts? Are they the same as fundamentals?

and I asked.....what program are you in? and your response was.....
Sep 24 by RegenerativeNurse

I'm in the LPN program

They were very vague. I asked again and was told they mean topics such as 'what is blood pressure? Why is it taken? What does it mean? How would you treat a diabetic?'

But I thought concepts were theory.

What is ADPIE and how does that work/is it applied?

In some posts you identified yourself as being in a LPN program then that you graduated and passed your boards...all in the same month.....I remain very concerned.

There should be NOTHING triple digit to flush a tube feed unless your intention is to have the flush come out their ears.

Think about it....a 100ml's can flush that tiny feeding tube AT LEAST 10 times over...each feeding. How many HEALTHY 2 year old babies drink an 8 ounce glass of anything after each meal. You have no idea how to care for this baby and the agency could care less. A dangerous combination.

You need to consider very carefully about this job.....but it is after all your license. You need to think about what you have been told here very carefully. You are obligated as a nurse, let alone a new grad LPN, to not accept assignment that are out of your skill level....especially when you are alone. do you know how to set up care for this infant? It requires more than giving the meds an following orders. You need to know how to set everything up, know it's use, set up the environment, know what equipment how to use the equipment...you have no background or knowledge for this....and the agency could care less about wither of you.

My concern is for the infant under this agency's care....personally I would run from this case and agency if they are unwilling to properly train you and orient you. I know this sounds harsh...but you need to take a step back and really think about this and your ability to care for this baby....and the agency who is letting you because they don't care. I am so sorry this may seem harsh....but they are taking advantage of you....of your newness....You have no way of knowing....and it will hurt you in the end.

I really do wish you the best.....good Luck

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Specializes in Med/Surg, Academics.

I need to add to the voices saying you need to run from this agency. I now do PRN home care for adults only in addition to PRN acute care. I have two years hospital experience, but an interest in peds home care. I told them I will not take call for peds until I'm properly oriented to peds and the specific case. You are on your own with home care, and it's a dangerous situation for the patient if you don't know what the heck you are doing. Please, please rethink this job.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.

I was recently looking for a job & went to a PDN agency. It was me, an RN & a new grad LVN in a room for orientation with the agency. You could tell the new grad was nervous. This would be her first job. The only clinical experience was in clinicals. So they show us videos, test us on CPR & how to change out a gtube. They told all of us that they would start us where we felt comfortable - for the new grad it would be with a "stable" patient with just a gtube. Also they said to ask for as much orientation as needed. But I can tell you when she was fumbling trying to put the gtube in the baby she didn't know what anything was, it was scary. I don't think they hired her, at least I hope they didn't. Because when you're out there, you're alone. They promise you this & that to get a warm body in the house, but after that you need to be 150% confident in your skills. Especially if it's just you & the child at home.

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Okay, I initially started my reply without reading everyone else's post. Then I saw Esme's long post and it made me got back and read.

Now, I have no idea what they teach in nursing school in regard to pediatric g-tubes. Children with g-tubes that are medically fragile generally have very specific amounts of free water that are given to them to prevent dehydration and keep electrolytes balanced.

There are numerous posts in this forum regarding new nurses. For any of them that are pro-new-nurse, there are some caveats such as a supportive agency, supervision and generally a family that knows what they are doing. This agency is not offering enough training or support to be hiring inexperienced nurses. They are not only risking your license but your patient's life.

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Specializes in Complex pedi to LTC/SA & now a manager.

Inexperienced new grads should not be working with new clients just discharged from acute care with a medically complex history, especially if this is a new diagnosis and the family does not have a qualified experienced caregiver.

(And a newly discharged complex child generally doesn't have a qualified competent caregiver as this person is just learning the role and needs a lot of education and support)

You posted that this is a newly discharged 17 month old with shaken baby syndrome, high risk ^ICP, fluid restrictions , new GT, high risk seizures. And you have not clarified an illegible order handwritten by another nurse. You plan on giving a complex infant 100 mL H2O flushes post feed because that is what the illegible order reads like?

. Reputable pediatric agencies have extensive training and preceptorship programs for nurses without pediatric experience. For example a nurse who worked for years in adult med-surg or LTC would be required to go through a 16 hour classroom training and full day lab on pediatrics with skills competency testing and a minimum of 24 hours (3x8h shifts) with a qualified trainer/preceptor for their first case. The next 2-3 clients would be 8-16 hrs precepted.

Many pedi agencies require nursing experience of at least a year as you are on your own in the field.

You previously stated that this same agency sent you to a pediatric trach vent case night shift as your first independent experience!?!?!?

BOTH agencies I work for require nurses to have minimum experience and 6+ pedi home health experience before sending through a 16+ hour trach-vent class with hands on lab and specific precepted clinical experience. Even a new hire with documented pediatric trach-vent experience must demonstrate clinical competency and work their first shift under a trainers supervision before being independently scheduled.

I understand the need to work but many new grads do not know what they don't know. I precepted a new grad who's answer was well I was an EMT so I can handle any emergency. Good luck with that. Chronically ill, medically fragile/complex children do not follow the "rules" of typical children. They are unique with specific orders and often treated by some of the most highly trained medical professionals in the nation.

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