NS through peg?

[I_LOVE_TRAUMA, RN]

I had a long hold the other night, a NH pt. with a peg tube. I got orders to continue the prior tube feed orders and to flush the peg with 300 cc NSq4 hours. I wasn't sure what to flush it with and most of the other nurses didn't know either. One nurse said we were just to use the normal irrigation bottles of saline (you know the large square ones). I know this is stupid, but is that what you use? And this pt. had a PICC already, wouldn't it be easier to just treat her NA deficiency with IV fluids (she was SL)? Just curious...thanks! I sometimes forge the longer term maintaining stuff.

[suzanne4, RN]

That is a very odd order. Normally it is free water that is given via the PEG because you cannot give it IV.

It is used to lower the sodium level.

Always better to treat a deficiency via the IV in this case as well, especially since she had a central line at that.

Have never seen one to give 0.9% down the PEG in my entire career.

[I_LOVE_TRAUMA, RN]

That was what I thought (free water), but the docs that were on said that this was a common order for people on the floor with different injuries?? But I didn't have time then, and haven't sense to inquire with them about it further.

[Annisme]

I usually see orders to flush a PEG w/30 mL sterile water...300 seems like too much, whether it is NS or water...

[Dempather, RN]

When I used to work on the floors, it was free water flush q 6 hrs to lower sodium, like Suzanne said. The amount doesn't seem so concerning - usually they would say 200cc or something of that sort. Think about it. Would you drink normal saline (or salt water)? It's all going to the same place. :)

[CoffeeRTC, BSN, RN]

Did that person have an electrolyte imbalance?

Tap water is what is used. You don't drink sterile water do you?

[qhilldogs]

in 10 years I have never seen an order for NS in a Peg tube :)

[mauxtav8r]

Did that person have an electrolyte imbalance?

They do now . . .

[I_LOVE_TRAUMA, RN]

Yes, the exact order was.. 300cc normal saline flush q4hours

[BEDPAN76]

I've never heard of it either....Hope they were on aspiration precautions! :barf01:.Also would be interesting to see the labs.......

[ktwlpn, LPN]

I would have called the doc to clarify-I have never flushed with anything other then tap water and as someone else said 300cc is alot...

[travel50]

We recently had an order like this at our nursing home, 50 cc NS per Peg tube q 4 hrs. She also had a central line. I'd never heard of such in 26 yrs of nursing. So I called the doc back for clarification. The patient has an anoxic brain injury. The doc said that with certain types (areas) of brain injury, the patient will keep a low Na. He said it would work fine to give it per peg or per IV. He felt it would be easier for us to do it per peg b/c since she has a central line, only an RN can touch it. We now have RNs around the clock, but he still said to do it per peg b/c it was just easier. (Also less chance of infection doing it per peg he said). So we do it, and her Na level is now staying normal.