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Discussion

NS through peg?

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.

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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.

Also orders of magnitude cheaper. Have you looked at what pharmacy charges for a bag of NS vs what CS charges for a bottle of NS. Not a bad way to do things.

David Carpenter, PA-C

good ole tap h20, the gut isn't sterile, ? was the pt receiving maint IVF as well??

In my unit we put NS down PEG and NG tubes fairly frequently. If the patient is hypernatremic then we use free water. If they have problems with hyponatremia then we use NS.

I have heard of the NS order before. 300ml isn't unreasonable but it is the largest bolus I have seen.

Per a MD from a few years ago--One of the reasons to use peg flushes (whether NS or good ole tap water) instead of maintenance IVF is that the tube feeding formula is usually too concentrated to use by its self. It has to be inconjunction with a water (or saline) to prevent diarrhea. After he told me that I noticed that patients who had scheduled water flushes did better than those who just had just tube feeding ordered.

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