peg tube dislodge

[supaflyz]

Hello fellow nurses,

I have a question to ask you guys. Normally this wouldn't be a problem as I am able to get the responsible verbal consent over the telephone for a new peg tube to be place in.

Today while doing rounds during change of shift report, I notice that one of my patient's peg tube was dislodge. It was lying on top of his abdomen. He wasn't in any pain. His vitals were stable. The morning nurse and I place a temporary tube in there. I called the physician right away. Got a stat order for a KUB to confirm temporary tube placement, schedule an appointment to get a new tube place in, and to hold all medications and feeding until new tube was place in. I called to get a KUB and there was no GI obstruction and the temporary tube is in place.

The problem here is that I tried calling the responsible party. It rang 2 times then busy tone. Then I try calling again and it said the caller has requested no incoming calls. I tried the next number listed as his friend. The guy told me he didn't even know the patient and was wondering why his name and number was listed on the face sheet. Then I called the next of kin (The patient sister) and it said the Cricket number is no longer in service.

Well I tried calling her other number and left a message. About 3 hours she called back and I inform her that we need to place a new tube in, but her niece the responsible party needs to give verbal consent over the phone in order for us to schedule an appointment. The whole time I was trying to reach his daughter but with no luck. The same message kept coming up.

So I called the assistant director of nursing. SHe told me you did what you could. Just make sure to document everything which I did. I also called the director of nursing to inform her of everything. She told me to try again before shift ended. Then just leave it in the 24 hour report to try to follow up in the morning to see if his daughter could be reach. If not then the physician will have to override the consent from responsible party so patient could get a new tube place in. I check on the patient routinely and he is fine no pain whatsoever and alert.

I check on him around 8 pm and hes fine and vitals are stable. Check on him before my shift end and he was sleeping. He woke up and was ok. Throughout the shift I try to contact his daughter every 40 minutes or hour and still got the same message. I documented every time I call his daughter.

It was pain staking because I work at a place that still has paper charting. I'm at home now and is a little worry because the patient didn't have any medications or feeding since 2:30 pm. I left the facility around 10:30pm. I'm worry because I'm afraid something might happen. Another patient had the exact same problem. I work at a rehab/long term care facility so they don't have anyone to put a new tube in. Have to wait till monday morning for a new tube to be place in. We have to wait for the daughter to give verbal consent before scheduling an appointment with the EMS to pick him up and the facility where the new tube will be place in.

[RunninOnCoffee]

It sounds like you did all that you could. Any reason an NGT couldn't be placed in the meantime to give meds and feed until the PEG can be resolved? That way your patient doesn't have to go without until Monday.

[supaflyz]

I never really thought of that. This facility always send patients out whenever a peg tube is dislodge to put a new tube in. Usually its done the same day. However, they don't place new tubes in on weekends.

[Pepper The Cat, BSN, RN]

We use a Foley catheter as a feeding tube and usually start using it right away. As for reaching family, sounds like you did all you could. When someone does reach the NOK, they should ask for alternate numbers, or maybe in email address?