Off and on I have this problem w/my resident. Her g tube will not hold the feeding tube part (the purple cone) it will keep popping out and needs to be taped to hold.
I thought the problem was air, so I've tried holding the g tube up, I've tried attatching the piston syringe as well to see if that helps. Drawing back of course pulls the stomach contents, so that doesn't seem to help.
The nurses I work with don't have any other suggestions and just said it's normal to sometimes tape them. I could see that if the g tube port was stretched out and doesn't hold anymore, but I found out after taping it, a while later (sometimes days) all of a sudden the tube will hold snugly.
I already tried googling for answers and couldn't find anything other than expelling air by holding upright...so I'm coming to the experts! Can anyone shed some light on what's going on? Maybe it's not an air problem but I don't know why it does this and it's a pain to keep taping it.
I'm glad you are doing some good problem solving with this patient. It's been a long time since I dealt with adult g-tubes. They would stop holding together after a while. This was a particular issue with the formulas with higher fat content. Regardless, the connector end would separate with just working it a little then I would wash the connector with soap and water (using a cotton tip applicator to thoroughly wash the insides). This would accomplish the same thing as what a previous poster suggested to clean it with alcohol as alcohol defats surfaces. Most of the time this would solve the slipping apart issue. Sometimes the connector is just stretched out and you would need a new one but it sounds like you would have trouble getting your hands on a new one.
My advice to you is to do exactly what YOU know the right thing to be. Do everything the way you were taught according to standards of practice and NOT what your fellow nurses tell you to do. It doesnt matter how long they've been nurses or "this is the way we do it here".
when you are on that witness stand in a lawsuit, YOU and you alone will have to answer for your actions or inactions. so when the lawyer is grilling you about why the patient had fluid overload, chf, aspiration pneumonia or a myriad of other things, you will be able to say you checked that residual and put the feeding on hold. but if you dont check that residual AND chart it, then you will be deemed as guilty as the rest of them by the jury.
i know that scenario might be a little overboard but thats exactly what can happen.
no matter what, do what YOU know to be the right thing to do. in this case, you KNOW you have to check for residual on a tube feeding along with auscultation.
as my nanny told me "if your friends jump off a bridge, are you going to jump too just because they tell you 'thats how we do it here'?"
another thing i would say would be not to take someone's word for it "thats what the doctor wants" (or doesnt want for that matter). if you know something isn't right with your patient (like her hyperglycemia), then please be sure to document YOUR attempts to have the doc eval the patient.
at my facility, some nurses used to like to chart "charge nurse notified". ok, thats all well and good but what did YOU do about it? cuz that's what the lawyer is going to ask.
I so dislike power tripping MDs who don't see us as part of the "team." I wish I could petition to have them fired, but they are the bread and butter of the system, aren't they?!
Follow up question: What does this patient's stools look like? Is she having stools regularly?
Oh don't get me started! I asked when I went on this afternoon what the doctor said and I was told THEY DIDN'T SEE THE POINT TO CONTACT HIM!!!! Seriously?!
Well things went okay. No residual tube held fine, until about 915p. Started with the bile drainage. It would ooze out and I could pull about 20cc's before meeting resistance. I was told to write in the doctor's book and it was too late to contact him?! He doesn't return pages anyway so, probably moot point. I rechecked in an hour and it was the same, so I turned the feeding off. It doesn't seem right to force it, yet I couldn't get a straight answer from the nurses who were left.
To the poster that said to document, oh yes...I have the 'ol CYA ingrained in me. Came from my previous career, we had to document things like fiends...way easier though...all done on computer in sort of free form. Anyway I did what I could. I disconnected the feed, can't see running it with bile oozing out. Ran it past the oncoming nurse and she agreed with me.
Hopefully tomorrow will bring some sort of resolution and then I'm actually off for a whole weekend! *wine Hopefully some better days are ahead, this week has been rough.
I am not a Nurse or any other medical provider. I know this post is old but I'd like to share information in the event that someone still reads this.
We'd like to offer a suggestion for our tubies that experience phantom back pressure and unexplained pop-off (not due to back pressure). After having these issues and googling ridiculously we found essentially 2 responses....1) Tape the heck out of the tube and it's connections 2) Go to the Dr. where they seemingly only offer replacement of the hardware as a solution. After putting some thought into it, and some trial and error, we came up with what seems to be a very viable, cheap, and easy solution. It has worked for us for the last 3 occurrences with no problem and maintains itself for at least a couple weeks after. When the ghost pressure occurs again we repeat the process and are good for another couple weeks.
We are not medical professionals. Consult with your doctor before trying this method.
Good luck...keep us posted on your results from this if you try it.
A brief summation is that we have taken Teflon tape and wrapped it around the Christmas tree fitting. We then insert the Christmas tree fitting into the feeding tube connection while maintaining gentle pressure to keep the connection together. We then rotate the fitting within the feeding tube clockwise then counter clockwise a few times. We remove the fitting and then remove the Teflon tape from it. I don't know the science behind it but this action has been able to re-instate the grip of the fitting to tube valve. The effect seems to last 2-3 weeks. When ghost pressure occurs again we repeat the process and achieve another 2-3 weeks before necessary again. Good luck...hope this helps.
I had this issue with a couple G-tube patients. It is from gas pressure in the stomach. Neither had issues with residual and g-tube placement was in the right place. Gas it was. See if you can get them simethicone or mylanta or something for gas .. to give prior to feeding that should help with the gas in the stomach. Sometimes leaving the tube open (surround your patient with towels to absorb contents) will help release the gas.. or repositioning too.
This is an older post but I answered something similarly a while back in the GI forum. I ascribed the disconnection to the ends of the feeding tubing and the inside end of the GTube to being 'greasy' and needing degreasing.
I figure enteral formula must have some fats/lipids in it and the equip becomes greasy. I would just use an alcohol prep to swab the end of the GTube and the end of the delivery set, let it air dry and then reconnect. Usually always worked like a charm. Of course I made sure all other possibilities could be excluded and the tube was patent without any residual problem.
Seriously, just try it. I found taping the tube would just 'gummy up' the junction. Then I learned my 'trick'.
1) residual checks: we check residuals Q4, I don't know why your charge RN would say otherwise . . how else will you know if you might be feeding too fast?
2) disconnection problem: a simple check to see if air or too much residual is causing your problem; just get an emesis basis or other container, disconnect the feeding tube and let the PEG drain by gravity. If little or nothing comes out, then your problem isn't pressure, but if a liter drains out fast, you may be feeding too fast (the patient may have gastroparesis)
3) disconnection problem, part 2: the cone connector disconnecting from the PEG. often with PEG's that have been in for a long time, the PEG end is just dilated and you need a new PEG inserted. But, sometimes, the PEG end and the feeding cone get all slimey and won't hold . . . clean both the PEG tube end and the feeding tube cone with alcohol swabs, get them both dry with 2x2's and reconnect. Usually, the clean, dry surfaces will hold much better.
checking residuals q4H is ridiculous for someone on a long-term regimen.
Add a kangaroo port to the gtube port. Add a little plumbers tape (Teflon tape) to the purple "Christmas tree" end before shoving it into the gtube port. It is for plumbing and is non toxic. It works awesome!!
You could probably add it to the feeding tube end but would have to reapply it each time. The kangaroo is better and you can replace it fairly regularly.
Can anyone shed some light on what's going on? Maybe it's not an air problem but I don't know why it does this and it's a pain to keep taping it. 
TiffyRN, BSN, PhD
2,316 Posts
I'm glad you are doing some good problem solving with this patient. It's been a long time since I dealt with adult g-tubes. They would stop holding together after a while. This was a particular issue with the formulas with higher fat content. Regardless, the connector end would separate with just working it a little then I would wash the connector with soap and water (using a cotton tip applicator to thoroughly wash the insides). This would accomplish the same thing as what a previous poster suggested to clean it with alcohol as alcohol defats surfaces. Most of the time this would solve the slipping apart issue. Sometimes the connector is just stretched out and you would need a new one but it sounds like you would have trouble getting your hands on a new one.