PEG Tube Residual

[pikachu715]

Problem: Hospital protocol states that all PEG tube residual is discarded. However, family wants PEG tube residual returned to the pt. There is also a standing order by the doctor to "Discard any PEG tube residual. Follow hospital protocol regarding flushing, medication administration, and managing PEG tube."

I work night shift. I understand that if PEG tube residual is x > 2x the hourly rate, I hold the PEG tube feeding for two hours then recheck the residual. But to discard all PEG residual regardless whether it is 5 ml or 50 ml seems unreasonable. If the residuals were greater than x 300 ml I will definitely discard the residual and call MD.

I don't entirely agree with the hospital protocol to discard all PEG tube residual. My nursing supervisor states that I should call up the hospitalist in the middle of the night and talk to him/ her about the family concerns. What will you do?

[EllaBella1, BSN]

If the family is adamant that it's returned I would do what the supervisor says and call the hospitalist. Otherwise I would explain to the family that both hospital policy and orders state that it is to be discarded and that your hands are tied at this time. Tell them that you have notified your supervisor of their concerns, and that the doctor will be notified first thing in the morning. Then follow your orders for the time being. If you choose to side with the family without the orders it will be bad news for you. When the next nurse refuses to return it I can pretty much guarantee that the family will say something along the lines of "well the last nurse did it" which will open up an inquiry into why you didn't follow your orders.

[MilliePieRN]

I learned in nursing school "it's not yours, put it back". I'd document the family request. Maybe pass along to day shift the request and how you handled it. I don't know why your hospital policy is to discard, I agree with the family. (And they sound like they know what they are doing and have handled the peg on their own?). Depending on the amount you are removing, there is a possibility of messing with ph taking it away q2h.

I'm assuming this is a long term peg that the family manages on their own and not a fresh peg and surgeon ordered protocol. My view would change if that's the case.

[EllaBella1, BSN]

I learned in nursing school "it's not yours, put it back". I'd document the family request and not worry about it any more. Maybe pass along to day shift the request and how you handled it. I don't know why your hospital policy is to discard, I agree with the family. (And they sound like they know what they are doing and have handled the peg on their own?). Depending on the amount you are removing, there is a possibility of messing with ph taking it away q2h.

I agree that it's a stupid policy, and that the family sounds like they know what they're doing here. But it's also not wise to deliberately go against hospital policy, especially when there is an order which states to follow it.