PEG tube policies.

[LadyMadonna]

Hi. I am embarrassed to post this because I know it is basic nursing knowledge (I work in a LTC facility where I have worked since I got out of nursing school a few years ago) but I have a question about PEG tubes. Until we became a skilled facility a couple of months ago, we did not have many patients who were tube fed.

I have several patients on tube feedings now, and last night had one who had some nausea and vomiting on the previous shift and was given phenergan. I checked her residual after I came on and it was 60cc. I had no idea what the policy was on this. I checked the book the facility provided regarding skilled patients but tere was nothing. I turned off the feeding and when I checked an hour later there was still about 15cc of residual so I left the feeding for another hour and this time there was no residual so I turned the feeding back on with good results the rest of the evening.

But for charting's sake I did not know what to put.

Is there perhaps a website that outlines nursing skills? Someone told me that limiting your career to a nursing home would cause you to lose the skills you learned in school, it looks like they were right.:imbar

[NeuroICURN]

First of all, I wouldn't get down on yourself for working LTC. Working LTC requires certain skills that you don't use in acute care.

As for holding for residual. In the ICU, we generally don't hold for residual unless it's at least >100cc. We sometimes don't hold until it's >150, but that's usually the minimun we hold for.

Also, we can use our judgement...if someone is just beginning feedings and after a few hours, I am able to pull back the entire amount put in, then I'll keep an eye on it. If it continues to be a problem, I'll mention to the doc that they need reglan Q6h or erythromycin.

Hope this helps.

I forgot to mention....this is just a G-tube, right??? not a GJ? If it is, then that's a whole other ball of wax. (I've heard several nurses refer to GJs or J-tubes as PEG tubes, so I just wanted to make sure)

[dwainlou]

WHAT YOU DID SOUNDS reasonable to me but, I would be concerned about the n/v on previous shift. Possible asperation pnuemonia. Get the docs to write you orders on when to hold feeding ,like check residual q 6 hrs and if greater than 60cc hold for 1 hr and recheck or if bolus check resid before feeding and hold if greater than ? You don't lose skills in long term you develope greater ones .You sound like a great nurse. Good luck

[weetziebat]

I work in a group home with clients who have developmental disabilities. One of our folks, with a PEG, gets their feeding all night, and we do not check residual on them. Another gets five feedings a day and we hold the feeding only if the residual is 200 cc or more.

But the concern about the nausea is valid, and I think you made a good call in holding the feeding - better safe than sorry. Now you just need to get feeding guidelines from the MD, so you'll know in the future, and it will CYA. Always a priority.

As far as LTC vs. hospital - there are different needs and we all have different abilities. And one of the great things about nursing is that you have options. I could never work with Alzheimer patients yet I have great respect for those who do. One area is not better or worse than another - just different.

[Tweety, BSN, RN]

We hold tube feedings based on the the rate, and hold for 1 1/2 times the rate. So if the rate is 100/hr we don't stop the feeding until 150 cc. If the residual is less than 100 we put that back into the patient, as this contains nutrients and digestive enzymes.

Don't be concerned when you find residuals in a patient, it's going to be up and down and because it's not zero doesn't mean they aren't tolerating their feedings.

But because the patient had nausea and vomiting, I agree it's reasonable to hold when symptomatic. Reglan is a good drug to promote gastric motility in tube fed patients. If the patient continues to have n/v and high residuals, of course notify the MD.

You definately need to have a policy and protocol in place that spells it out for you.

Good luck.

[medsurgnurse, RN]

considering that the patient had N&V that day, you did the rrigth thing in holding the feeding. Although there may not have been a written policy , yo u followed your instinct and held the feeding, better hold it and be safe that n give it and risk vomiting and aspiration