KelAyne

Thank you all so much for your replies. I really appreciate the input. We don't ever check pH levels - we don't even have test strips available that I know of. Until about 6 months ago we would insert a foley to keep the stoma patent and send them to the ED for eval and replacement - then suddenly we had a supply of extra gtubes and the RN's were expected to replace when necessary. I was uneasy about it but never having been in the situation I didn't voice all of my concerns (stupid, I know). Tomorrow I'm going to ask another supervisor if we can have an in-service. I'm still confused about the proper way to determine placement after x-ray. As a LPN student I was taught auscultation, as a RN student I was taught aspiration with or without pH and that auscultation is too hit and miss. Nobody seems to be on the same page - I just want to do right the right thing for my patients. Sometimes nursing makes my head spin Thanks again guys, ~k

This is my first time posting - not sure if this is the correct area to post in. I have been a registered nurse for exactly 2 months, a LPN for 5 years prior to that with 2 years experience in a sub acute rehab facility. Today, for the first time, a patient's Gtube dislodged from her stoma site while she was coughing. The stoma site had enlarged over the past year and had been leaking her feed/stomach contents from her stoma site for awhile. It caught me off guard, especially when I saw the balloon was still inflated with 10ml's of fluid. I called my supervisor who came down, reinserted a larger bore tube, instilled 10ml's of fluid into the proper port then asked me to check for placement. I instilled 10ml's of air into the tube and placed my stethoscope over her epigastric area, as I injected the air the second port popped open and I heard nothing - big surprise. When I told my supervisor I didn't hear the familiar gurgle she said 'no wonder, look where you put your stethoscope'. She then told me to place it well below where I had placed it around the umbilicus region - I did as she said and heard the 'gurgle'. My question is if I can hear the 'gurgle' over the epigastric area (as I had earlier in the day when I gave her meds) and over the much lower umbilicus section - how do I really know if it's been properly placed? Especially since the stoma is now so large and the caustic stomach contents are constantly in contact with surrounding tissue. I'm concerned and confused and I more than a little upset - my supervisor went on to make a few derogatory comments about my nursing practice. As an aside, during clinicals, I was discouraged from using the air instillation method the main reason was that it is often ineffective at determining placement and used to say why would you want to just keep pumping the stomach full of more and more air all day. That is the way we are required to check for placement at my current job so I have continued even though I would like to use the pH method. Eh, frustrated, sorry for the long post. ~k