Patient on tube feeding, initial rate 20ml/hr then advance 10ml Q12hrs. Patient has just been advanced to 50ml when NG tube inadvertently removed by confused patient.
NG replaced 6hrs later, do you restart at 20ml/hr or go back to 40?
I'd probably ask for a clarification order one way or another or be conservative and restart at 20mls.
But I'd also be interested in what the heck was going on with the patient. Was the dislodged tube new? Was it replaced six hours later under sedation? Are bowel sounds active? Etc.
Right... dislodged tube was 48hrs old; new one placed 6hrs by IR; active bowel sounds.
Lots of things to consider....what were pt's residuals prior to the tube being pulled? Are there medical problems that can make him at higher risk for low motility (i.e. diabetic gastroparesis)? Are there things about him currently that make him higher risk (i.e. lots of pain medication, minimal mobility)?
If a patient is tolerating (defined by no uncontrolled diarrhea, N/V, appropriate residuals, active bowel sounds) then it's reasonable to start it back at a higher rate. But when you're getting the order from the provider to replace the NG, you can also get one regarding the restart rate. Your hospital policy might have a section about restarting tube feeds after having it held for an extended period of time.
You would need to start over at 20 ml/hr. Then assess blood sugar, bowel sounds, orientation status etc.