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.
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.
yep, you certainly need to know what type of gtube the pt has.
those ones you yank out are the ones with the foam mushroom caps, which keeps the tube in place.
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.)
i've changed many a mickey g tube, i've replaced g tubes with foley's. all humane. what's with yanking a tube out with the bulb in place? it's horrifying and hurts like heck? i loved the patients i cared for in private duty and i could not and would not do that particular procedure. the nut doctor who put it in can be the one to pull it out. maybe he would think next time to use a tube that comes out easier call me a wuss!
An older, kinder physician taught me and several new grad how to replace a g-tube years ago. I have done it several times, always used a 16 Fr foley unless site is very small. He stressed site care and dressing changes too. It used to be a frequent occurrence that physician taught us useful skills. Not so much anymore.
leslie :-D
11,191 Posts
yep, you certainly need to know what type of gtube the pt has.
those ones you yank out are the ones with the foam mushroom caps, which keeps the tube in place.
thankfully, i haven't had to pull many of those.
leslie