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Help. Input. Agree. Disagree. Thoughts.

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by NRNPH NRNPH (New Member) New Member

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You are reading page 2 of Help. Input. Agree. Disagree. Thoughts.. If you want to start from the beginning Go to First Page.

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4 minutes ago, NRNPH said:

oh no. I don't know how long its been "uncovered". It could have been during transport. It's made on the first floor then moved and stored on our floor until we end up needing to use it. So I don't know how long it's been "open". If it happened in such a short trip I would have changed the bagging and be done.

Since you don't know how long it had been uncovered, I agree with your decision to not administer it.  Although enteral feeding is not a sterile process, we wouldn't feed our PO patients questionable food either.

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Just now, Golden_RN said:

Are the nurses mixing formula & then pouring the formula into a bag, putting that bag into the fridge for administration at a later time?  

It's a shame that you couldn't just prepare a new bag/tubing.  It just takes a couple of minutes.  In my experience, formula was always prepared at the bedside for immediate administration.

Also, do you have an infection prevention nurse that you can consult to make sure you are complying with infection prevention protocols?

 

We don't mix it. I believe the dietary unit does. But correct on the rest. I would have preferred to prepare a new bag/tubing. I didn't have one on that shift and I am sure we do.

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Daisy4RN has 20 years experience.

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11 minutes ago, NRNPH said:

Half of me wants to say I over thought it but the other half of me said I don't know the condition of the formula regardless of it being non sterile it was open to the environment around it because nothing was covering the opening. I honestly was thinking to myself I don't want to give my pt bad formula. They were already immunocompromised, doesn't mean its ok to compromise it more.

If by immunocompromised you mean in the medical sense (neutropenic etc) then I would have done the same thing because it would not be worth the risk bc you are right that you dont know where its been or how long it was opened. I have worked Onc and seen pt's get very very sick from what we think are the smallest things/situations. 

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Just now, Daisy4RN said:

If by immunocompromised you mean in the medical sense (neutropenic etc) then I would have done the same thing because it would not be worth the risk bc you are right that you dont know where its been or how long it was opened. I have worked Onc and seen pt's get very very sick from what we think are the smallest things/situations. 

You had to have PPE to be around the pt. I always remind myself to be more mindful of my PPE pts and their immune systems.

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43 minutes ago, Emergent said:

Would you worry so much about a glass of milk or tray of food? 

You are overthinking this IMO. Enteric feeding is not a sterile procedure. 

 

I think I would. Like if a can of soda was open by the time it got up to my unit/patient I would serve the can of soda even if technically the soda in the can might be fine.

 

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6 minutes ago, saongiri said:

I think I would. Like if a can of soda was open by the time it got up to my unit/patient I would serve the can of soda even if technically the soda in the can might be fine.

 

wait you would serve the soda or you wouldn't?

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5 minutes ago, NRNPH said:

wait you would serve the soda or you wouldn't?

No I wouldn't.

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I do understand your concern but why not take it a step further and be concerned about what dietary is doing with it? And you also should have been able to estimate the max time the tubing was exposed, because it should be labeled with the date/time it was mixed/put into the bag with the tubing. If those things aren't happening you have more to worry about.

I fail to see what would be so difficult about nurses mixing/spiking TF at the bedside.

I have zero idea what I'm talking about here but if this is some situation where there's bullk stock of this somewhere that is being mixed, portioned out and spiked in dietary then sent around to floors, you probably have even more things to worry about than the cap on the end of unprimed tubing. Realistically speaking.

Anyway. FWIW, I would've spiked it with new tubing and primed it and hung it.

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1 hour ago, NRNPH said:

We don't mix it. I believe the dietary unit does. But correct on the rest. I would have preferred to prepare a new bag/tubing. I didn't have one on that shift and I am sure we do.

I kind of question the whole procedure - from an infection prevention stand, but also the nurses not having a back up supply on the unit.

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JadedCPN has 13 years experience as a BSN, RN and works as a Pediatric RN.

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If the formula would have been primed all the way down to the open end where the cap was missing, I wouldn’t have hung it. But the fact that the tubing essentially wasn’t primed at all, so there is a large distance gap between where the end was “exposed” and where the formula is actually being held, yes I think you overthought the situation. I would have hung it after disinfecting the end of the tubing.

This isn’t like giving someone a can of pop that has been opened and sitting out, because that is a direct and short entry from the environment to the pop so the chances of bacteria entering are higher. Those kangaroo feeding bags are feet long, that’s a long distance and not direct. Just my opinion though; it’s definitely a judgement call. 

ETA I agree with a previous poster that the entire practice is not optimal. The fact that you don’t have immediate access to a backup supply of formula also would have swayed my decision. If the patient has a condition or is getting medications where the feeds need to be on a strict schedule (ketogenic formula, hypoglycemic issues, etc) and I don’t have a backup supply of formula available, I definitely would have used that formula in this scenario.

Edited by JadedCPN
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Kallie3006 has 6 years experience as a ADN and works as a Jack of all trades, master of none.

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We spike or pour our tube feedings at bedside as well so I do not really understand the whole concept of the bag being mixed beforehand. Our pharmacy mixes our TPN and lipids and they have their proper procedures for that mixology, but to what measures is the dietary department taking when mixing these formulas and transferring them into the administration bag?

I would have also used the formula as well, especially if there was not an available alternative.  You state that the patient in question was immunocompromised, so I do understand the concern for risk of infection, however, how much time and feedings were lost due to the feeding not being given?  That is nutrients missed that the patient needs in order to aid with the healing process.  I'm just curious if the attending doctor for this patient had anything to say as to the missed feedings.  

IMO this seems to be overthought, realistically the distal opening of the tubing is a ways from the collection portion on the bag, nor is this process a sterile technique

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OyWithThePoodles has 10 years experience as a RN and works as a Registered Nurse.

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Personally, I think it's a bit silly that the bags are spiked and left in the refrigerator, I really hope there is something I am missing because it takes close to no time to spike and prime new tubing. Also, not having tubing readily available should you need it, is alarming. 

I get what you are saying, but what about that apple on your patients side table? How many times is it touched and moved by hands, gloved or not. You know the patient isn't getting up to rinse it off before taking a nice big bite. (Eww btw.)

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