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Discussion

? about my peds patient

Hi all I am a PDN but this is a peds question. I am caring for a little girl and I do mean little. I won't share anything identifying just in general. She just turned 4 but because of her condition she is very small about 20 pounds. She has severe scoliosis making some of her anatomy a bit off, and a heart condition. She is completely immobile has a G-tube and gets TPN as she has no sucking or swallowing reflexes, and is palliative care. It is very important to me to make her as comfortable as possible. The problem is she has constant gas with cramping. We have tried what we know to do. We keep her at a 30 degree HOB. We have tried formula at night and h2o during day and vice versa. We vent the tube allowing massive amounts of air out. Frequent positioning and simethicone which doesn't work anymore. I am at my wits end. Does anyone have any advice or ideas. I will take what I can get. FYI I am posting this with guardian's approval. TIA

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    • Featured Replies

    • Experts

    This is a tough one. How is all that air getting into her stomach? Could it be she's intolerant of her current feed? There are some antispasmodic meds that might help, but they have significant anticholinergic effects as well. Bentyl and Robinul are two. You might also try warm blankets or a hot water bottle on her abdomen. That's about all I've got...

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    I used to do PDN and my patient was having a lot of gas. He also had a lot of vomiting. His formula had been changed recently, so no surprise there. We ended up slowing the feed significantly. I would also lay him on the floor and rotate his legs as if he were on a bike. Think about a post-op patient who really needs to pass gas - if they are able, first thing you do is get them up and walk! My patient (and yours) couldn't do that so we have to do it for them.

    Other than what you're already doing, I don't have anything else to offer. In regard to the robinul, I'm not sure that would be more useful - it just made my patient constipated.

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    Farrell bag? Mixed results even if used per manufacturer instructions but sometimes it makes all the difference.

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    I just watched a video of how to use one... seems like a more complex version of a "chimney" feed.

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    • Author

    I just watched video on the

    Farrell bag as well I will show it to guardian's in the morning. I am giving the simethicone every 4 hours, have vented tube before each dose, have HOB elevated as high as is comfortable for her and am frequently positioning. So far so good. Thank you for the responses all are appreciated.

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    I am not a peds PDN, , but I am a mom of 4 kids... bicycling legs worked like a charm for my 1st child's colic and for my 3rd child (the only one who had issues w/ feeding) He got very gassy and bloated. Bicycling the legs helped immensely!

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    FYI Farrell bags require a physicians order.

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    You can also check the Oley foundation message boards for tips.

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    • Author

    Thank you justbeachynurse I will do that.

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    We go the farrell bag route in the hospital. They can be pains in the butt, but sometimes they do help .Just make sure you have them positioned correctly during feeds or you'll just feed the farrell bag. :)

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    Used to work in Peds LTC and so many of our kiddos would have constant gas. Ferrell bags work half the time. But we also used another bag, forget the name of it, but we would leave it on and they would be vented all the time except when feeding.

    Or we would do a slow 24/hr drip

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    • Experts

    In similar circumstances we got an order for Farrell bags, don't recall if they were remarkably useful but think they helped somewhat. As I vaguely recall, what helped the most was continuous venting (which we also got an appropriate order for).

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