Pulling G tube?

[jschut, BSN, RN]

ADult child gave ok to have tube placed after parent had a stroke.

Now, child is insisting that it be pulled on patient who is alert and oriented, and learning to eat again PO. Pt also walks, is continent of bowel and bladder, and talks (although with slurred speech).

Child does have POA and is healthcare POA.

Is this allowed to be done? Puling the tube, I mean?

Patient very tearful and afraid after child visited, and patient confided in a nurse (although begged nurse not to say anything to the child). Is there anything the nurse can do?

Is there anything anyone can do?

[leslie :-D]

is the pt fearful of the tube physically being yanked out, or fearful of losing an alternative access for nutrition?

the gtubes i've worked with, can be deflated and pulled out w/o any discomfort.

if it's sutured in, then absolutely not.

you should get input from the doctor...

but there's nothing illegal about doing this...

and depending on what type of gtube it is, not painful either.

good luck.

leslie

[jschut, BSN, RN]

It's not like that.... it's more like, "My **** wants me to die." *** wants to kill me!" All done while sobbing hysterically....

Patient does not WANT the tube removed. That's the whole thing. But the child, who now has the Healthcare POA, wants it removed because it is said that the parent ould not want to live that way.

Yet, the patient says otherwise.

Sorry I wasn't clear on my first explanation.

[rhondaa83]

Is there a social worker that your patient can talk to ? You need to make sure there is someone that she can vent to, that can make a difference. Not that we can not as a nures, but a social worker would be a great help.

[abundantjoy07, RN]

If the patient is oriented and still able to make decisions for himself then I don't think it matters that the child has POA. Doesn't POA only kick in when the MD determines the patient is not fully cognizant? If the patient is still cognizant, then they have the right to say yea or nay and no one else can make that decision for them.

If your hospital has an ethics advisory board, I would call on them to come and speak to the child and the patient. Also, the doctor needs to clarify the pros and cons and paint a realistic picture behind the G tube coming out or staying in.

[Pipsqueak, ADN]

From what I understand, the POA only makes decisions WHEN the patient is unable to make their own decisions. If this patient is awake, alert and oriented, why are they not capable of making their own healthcare decisions? Also, while this person is capable, he/she can also make changes as to whom they designate POA.

It sounds like social services need to be involved.

[Jolie, BSN]

Based on the information you've given here, it sounds like the patient is fully aware of the implications of pulling the tube and has expressed a clear desire NOT to have it done.

A healthcare POA is used only when the patient is incapable of understanding and expressing his/her own wishes. The child doesn't get a vote in this situation.

Please clearly document your interactions with the patient, notify the physician, consult social work and call the ethics committee, and if that doesn't work, consult adult protective services.

[heron, ASN, RN]

As I understand it, the POA has authority ONLY if the pt is unable to make decisions on their own.

If this pt is alert enough to understand the possible implications of pulling the tube and then being unable to take adequate nutrition orally, then she/he is competent to refuse to have the tube pulled.

I thing the suggestion about the social worker is a good one. Also, check with the ethics committee of your facility.

Sounds like the adult child may be a little confused about whether the tube is needed when pt is taking po.

In any case, pulling the tube against pt wishes when pt is oriented might constitute assault/battery. Check with your risk management person.

[jschut, BSN, RN]

The patient is a regular patient of mine, and the child literally demands that I remove it. This has happened twice, and when I say that I cannot without a Dr order, I am told to "Do what you have to do, but I want it out NOW!"

The child is very "verbal" one might say, and borders on the edge of unstable, in my opinion (although that doesn't count, I know).

The patient appears to have a fear of the child, wanting to visit, but yet when the child leaves, acts almost disoriented.

The patient has voiced to the Social Worker on an occasion previous to this one that the wish is to keep the tube, and has also expressed this wish to others in the facility, including myself.

This is our 2nd go around like this. The first time, there was no paperwork, now the child thinks that there is little we can do since the POA is now in the patients chart.

Charting is detailed and administration is aware.

[Jolie, BSN]

Please organize a team meeting with the physician, a representative of the nursing staff, social services, clergy, risk management, a legal representative of your facility and the adult child.

It needs to be made perfectly clear to this person that his/her abusive behavior towards his mother and the staff will not be tolerated, and will result in a restraining order if it should continue.

Also please formulate an emergency plan in case the child decides to try and remove the tube himself.

[RNsRWe, ASN, RN]

I second and third everything everyone has said here!

Maybe, in addition, informing this "child" that if he or she attempts to pull out tube on his/her own, it will be considered an assault and battery, as the patient is fully able to decide to leave it in and NO ONE has the right to screw with that against the patient's will at this time. Then the very concerned child can explain it to the judge, and leave you all out of it.

[morte, LPN, LVN]

if the patient appears disoriented after visits, is it possible the "child" is giving them something, ie med/etoh etc to cause this?....it would seem perhaps supervised visit maybe in order.....and did this "child" coherse (sp)

this patient into signing the POA? which of course makes it not legally binding.....social work and an attorney seem to be in order...