PEG feeding, kangaroo pumps & Morphine.

[carolmaccas66, BSN, RN]

Hiya all. I worked my first nightshift in about 20 years 2 nights ago, in an aged care/long term care place.

We had a long term patient in who had PEG feeds. I have used these before but they had an older kangaroo pump for the feed line. Anyway the carer and I were doing our patient rounds and before I started this patient's feed I asked where is their sterile saline to flush the feeding line. Well the carer (who was an EN but I don't know how long ago) said it is different in nursing homes - they don't use anything sterile. They had a plastic cup with tap water in his drawer and you just drew up 70mls to flush the line. Well I said other places I have worked always use sterile saline and she said it's the same as drinking tap water. Plus the tip of the line I had to insert to feed the patient in was lying on the floor. She said they don't sterilise anything, so I just flushed and washed the tip in the tap water and started the pump (which didn't seem to be turning as it pumped - maybe cos it was only 180mls going through 5 x per day, making it a up to a maximum of 900mls per full feed).

My question is is this normal not to use sterile saline? I was taught EVERY line has the potential to become infected if aseptic technique is not used. Even though it is like eating and drinking, I thought we still had to used sterile products - I have always followed what I was taught at university. I think this attitude is slack as 'they are only nursing home patients'. Well shouldn't we be following sterile techniques regardless of what setting the patient is in? What would you do in this situation?

Then I was told a patient needed Ordine at 6am. Well I said I'm the only RN on so who checks it (as no-one else was coming on till 7am). They told me the carers check it AND sign for it. I was pretty shocked because over east, (I'm living in the west at the mo), they would NEVER have a carer check and sign for any DDs. I don't even remember medication competent ENs checking DDs. Here in the west it has only been my experience as well that RNs ONLY check DDs.

Me and one other carer discussed it (she used to be an RN) and I explained how it is illegal and my license would be on the line etc.

Anyway I refused to do it, and when the other RN came on, we did it and that was fine, though she said carers do it all the time and I said I think that is illegal you know!

Is this normal? Would you risk your license by doing this? Cos I sure as hell am not.

What are your thoughts?

[K+MgSO4, BSN]

hi

Sterile saline or sterile water?? We have a long term jejunostomy feeder in at the min and she gets sterile (as far as it can be when reusing the syringe) water flushes.

But I think that PEG feeds have to be clean not sterile, look up the NH policy. But Eww on the tip being on the floor.

I worked out bush in NSW as the only RN on duty in a hospital with an ED. The EN who was not med endorsed had to check the drugs out with me as there was no other choice. Plus they are registered (enrolled) as well. Check with the WA board of nursing or look up administration of CDs in a NON acute setting. The rules often differ to take into account the staff available.

[carolmaccas66, BSN, RN]

hi

Sterile saline or sterile water?? We have a long term jejunostomy feeder in at the min and she gets sterile (as far as it can be when reusing the syringe) water flushes.

But I think that PEG feeds have to be clean not sterile, look up the NH policy. But Eww on the tip being on the floor.

I worked out bush in NSW as the only RN on duty in a hospital with an ED. The EN who was not med endorsed had to check the drugs out with me as there was no other choice. Plus they are registered (enrolled) as well. Check with the WA board of nursing or look up administration of CDs in a NON acute setting. The rules often differ to take into account the staff available.

I was always told to use sterile saline for IVs. PEG flushing I have always used sterile saline where I have worked, but you could use water too.

I will ring the NSBWA on Monday cos I have never heard of a carer/EN who isn't medication endorsed checking meds (any meds). I just didn't feel comfortable doing that. Surely it isn't legal? If you're out bush and there is only one other person on who isn't med competent checking meds, then what is the point doing our training? You could get a monkey to do it otherwise!

I will check on Monday and clarify it, but just wondered what had been other people's experiences.

[ghillbert, MSN, NP]

You do not need to use sterile solution to flush NGs or PEGs. There is a lot of literature about this.

I would not check off DDs with an untrained carer either.

[K+MgSO4, BSN]

It was an EN not a career so it was different, also I felt it was more that the balance of DDs was correct rather than them checking the drug as such.

But I have only ever used clean water to flush NGs or PEGs as the stomach is not a closed sterile environment. Sputum going down into it and the food people eat is not sterile.

[ceridwyn]

Same, had to check with someone- was an EN or Div 2 then, don't see the point with a pca, no registration board to deal with and never used sterile water in pegs or naso gastric