How much water is used in general to flush a pediatric G-J tube

[dicohen]

I have a girl in a school setting, age 3 years, who has a pediatric G-J tube. There are no doctor's orders for flush. Mother states that she only flushes gastric port, after her medications. Isn't J-tubes supposed to be flushed, with warm sterile water, every 4 hours for continuous feed and after each bolus feed? If so, what are the usual guidelines. Of course, I am asking mother for doctor's orders, but just want to know.

[JustBeachyNurse, LPN]

Never used warm or sterile water in the out of hospital environment. I understand in the hospital, especially after initial placement, sterile water is used.

We always used room temperature bottled or filtered water. The GI system/alimentary tract is not sterile and the acidic environment is good protection.

Anyhow the orders were usually 8-10mL H2O pre/post enteral feed and if off feed >4h (very rare due to duration of feed interval)

J feeds are generally continuous so q4h flushes were unnecessary while feed was running. Most JT feeds I encountered were 16-20hr continuous. So only flush needed was pre/post as the continual feeding kept the tube patent

I was always taught JT bolus feeds were risky and should only be on a pump since too quickly can cause distress or diarrhea.

[boogalina, ADN, ASN, BSN, MSN, LPN]

I'm a new graduate nurse, and had to figure this type of thing out at clinical (because the hospitalist and my preceptor nurses were kind of shrugging their shoulders). I don't have the peds specific knowledge, but I can recommend a great, recent article about tube management for you to read: The percutaneous endoscopic gastrostomy tube: a nurse's guide to PEG tubes. Simons & Remington; Med-Surg Nursing, March-April 2013 (here's a link: http://digitalcommons.framingham.edu/cgi/viewcontent.cgi?article=1023&context=nurs_facpub )

[KelRN215, BSN, RN]

I've never heard of giving bolus feeds through a J-tube, every patient I've ever had with a J-tube has been on continuous feeds. Yes, it was standard practice to flush the J q 4hrs and the volume would depend on the size of the child and the amount of flush they tolerate. For a 3 year old, I'd say 5-10 mL.