PEG Syringes

[jnrsmommy]

I want to apologize in advance for any errors in this post, as it's my first time using my cell to post. This situation was told to me by my coworker tonight from the evening nurse she relieved. We work LTC and state is here with us this week. The evening nurse had an inspector watching him hook up a GT and give a flush. He went to reach for the syringe hanging on the pole and was told that he could not use it because the syringe was left together and not separated in the bag. OK, so he went and got a new syringe, verified placement, and checked for residual, which there was not any. He was then going to give the water flush, when the inspector stopped him and told him he could not use that syringe as it was now contaminated. I have never heard that before. If it were me and my mouth, I would've asked to see the literature stating not to use the same syringe, but he kept quiet, got another syringe, then proceeded to finish. So I ask you guys, is this something new and we just haven't been informed yet???

[lllchillylll]

I have never heard of that before. I know that they syringe is supposed to be separated from the plunger but as far as the syringe becoming "contaminated" after checking for residual is ridiculous! After you check and put the contents back in, you then use the same syringe to put the meds in. I cant understand how it can become contaminated considering that the exact same syringe is going in the same place and its not like its come into contact with other things. I was followed by state during this pass and they never said anything about my technique.

Maybe your coworker accidentally contaminated they syringe by brushing it against clothing, sheets, or skin?

[diane227, LPN, RN]

This seems rather stupid to me. The stomach is not a sterile environment. When I use a syringe I usually wash it out with some hot water, check placement, push my meds, followed by water flush then wash out the syringe with hot water. I have never been told in 31 years of nursing that this syringe has to be changed out. I would want someone to show me this standard in writing.

[morte, LPN, LVN]

a bunch of whoo eee

[Tait, MSN, RN]

As a previous poster stated the GI tract is definitely not a sterile environment. I treat most GI tools as though they were dishes at my house: Wash promptly and dry. Then I switch to a new syringe about every two days or if the syringe becomes visibly unclean even after through rinsing.

Tait

[jnrsmommy]

Thank you guys for your replys. Was definitely something that we talked about at great length last night, and I've been looking all over the net for info, and nothing.

[nursenow]

In Calif you are supposed to change the syringe every 24 hours and label it with the date. The inspector was jerking that nurse around. g-tube flushing.. is not a sterile technique. I have known three nurses that challenged state inspectors on the spot and ask them to show where in writing it says they are supposed to do something a certain way. the inspectors were unable to and admitted their fault in the end. anything they critique you on is in writing somewhere or they can't do it. otherwise it is just their opinion on how it is done.

[ktwlpn, LPN]

How often do you change your g tubes and do you do it yourselves?

[jnrsmommy]

Us too, night shift changes the syringes out every night.

I just remembered something else I forgot to mention. Whether or not it has any bearing I'm not sure, but I think maybe so.

He was 30min late doing the hookup and flush (was due for 1900, he didn't get in there until 1930 b/c he had a resident fall and have a head injury and was trying to get them sent out). The inspector had even come to him at 1919 and question him why the feeding was not running when it was due for 1900.

[nursenow]

How often do you change your g tubes and do you do it yourselves?

You dont ever change the g-tube. A surgeon puts it in and only replaces it if there are complications. I had one that just would not flush and I couldn't rod it out. when i called the on-call MD, it turns out he is the one that put it in and he said "I was afraid this would happen, I think I got it too long". so I sent her out to the hospital and he changed it out. Turns out that for some reason the part of the tubing in her stomach got a kink in it.

[ktwlpn, LPN]

That's interesting-our facility has been changing g tubes routinely for years at the bedside.We ask that surgeons use a catheter with a balloon upon insertion and once the tract is healed it's a simple procedure in the LTC which is performed by any nurse.It is more comfortable for the resident and way more cost effective then sending them out every time a tube becomes blocked.

[jnrsmommy]

That's interesting-our facility has been changing g tubes routinely for years at the bedside.We ask that surgeons use a catheter with a balloon upon insertion and once the tract is healed it's a simple procedure in the LTC which is performed by any nurse.It is more comfortable for the resident and way more cost effective then sending them out every time a tube becomes blocked.

Yeah, every facility that I've worked at, the RN can change the tube in an established tract. This facility that I work at now is saying that the LVN can change it as well w/ training, but I've been looking into finding the info on that.