Had a pt the other day who's PEG came out on the shift before mine. The nurse called the doctor, and he said to insert a foley into the hole in the abd wall, then to resume the tube feeding through the foley, and he would be in tomorrow to insert a new PEG. She wasn't comfortable putting a foley in, so she tried (not very hard), and said she felt resistance, so the foley was not put in. She wasn't able to get a hold of the doctor (community hospital, no residents or anything, just the attending who doesn't always call back). I wasn't comfortable with it either, so I didn't even try. The doctor was very angry when he came in and there was no foley in. Any of you ever heard of putting a foley in a PEG hole? Is this even within our scope of practice? Sounds kinda invasive to me, and I don't like the idea of infusing the tube feeding when we dont have any kind of test to show where the catheter would reside. Honestly, I'm not even sure how that setup would work.
Awe...I feel for you. This happend to me about 15 or so yrs ago..I was working nights in a LTC..really, really new nurse. No other nurse on duty. Felt a bit weird about it and didn't want to seem stupid about it. Thank goodness, my sister was a nurse and worked nights, called her up at her job and bounced the idea off of her. I still laugh about it now.
Any supervisors on duty that you could have asked to come up and show you/ help you? I understand the docs that you can't seem to get a hold of (thats a whole other thread), but isn't there a house doc that you can call?
BTW...we use alot of these for feedings...pts with dementia love to pull their tubes out (even with the binders, etc in place)
Specializes in Jack of all trades, and still learning.
The nurse before me never wrote out the order to put the foley in, or even charted that he said to put a foley in, and I was unable to contact the doctor.
Just document this inforjmation. Under the circumstances you did your best. (((hugs)))
It sounds like the situation was more complicated by the fact that the previous nurse didn't document anything and you wanted to be on the safe side. I have never heard of putting a foley in a G-tube either!
You didn't mention what kind of facility you work in, but is there a charge nurse or someone else you could have gone to to find out more about this practice? I've only been a nurse for about a month and constantly ask the more experienced nurses about things I'm not sure about. We were told in school that there is always someone out there that knows more than you and you shouldn't hesitate to ask!
hmmm I have been a nurse for 10 yrs and never heard of that. We always call the doc and they just schedule them for peg placement. ITs done in endo and even in the room in icu. As for med surg I have never seen it.
This happened to me as a brand new nurse too (less than 3 months experience).
Called the doc, who was flat out and couldn't come to replace straight away, but was happy for me to have a go. Well I'd seen a couple done on this patient and decided to give it a shot.
Pt. was confused and resistive (which made matters more interesting). The tube however - I was surprised on how easy (this one anyway ) was to replace.
I felt really good walking out of work that day.
Nicky.
(P.S. Up til that day I had no idea it was in my scope of practice either).
Keep in mind that when pts have G-buttons- Mic-Key, Bard Button, etc that they get changed on a regular basis as well as frequently checked fro balloon volume. The nurse takes the old button out and puts a new one in. Replacing a pulled G-tube is a similar procedure.
One thread like this is why I'm willing to wade through 10,000 about how nursing sucks, doctors suck, families suck, other nurses suck etc. etc. ad Zofran. Thanks everyone!
A big thank you to all the facilities out there who have policies in place for replacing g-tubes without an ED admission. It puts already at risk patients at further risk, even just exposed to the ED germs when our doc pops a foley in the stoma. We don't isolate people until labwork comes back, so there's all sorts of nasty bugs in the ED and an elderly person with a PEG is the last person who should be exposed to them!
Thanks for posting this. I've never heard of this either. And I work with lots of PEG tubes. Never heard of one coming out though, and what to do. Very valuable info.
Also if it helps, the proceedure for taking a g-tube out (for some botton types) is to get a good grasp on the thing and yank (after the patient has been NPO for ~12 hours). It's horrifying, because it hurts like heck, and the patient looks at you with teary eyes like "what did you just do to me." The pain quickly subsides, the stoma closes up and the pt can eat soon after. (If a foley is in, it is much easier, just deflate the balloon first.)
On a related note, SP caths routinely get changed by nurses.
) was to replace.
NewEnglandRN, RN
486 Posts
Thank you, OP, for posting this topic. I never knew this!