Questions about g tube

Posted
by nursegreenbean nursegreenbean (New) New

when checking for residual, in regards to a g tube,l I would expect it to be green, clear, the color of the last feeding,or meet resistance right away meaning there is no residual. If the gtube has migrated out of the stomach what could I expect to see when I check for residual. Any tips for getting the residual into cups without making a mess. The P &P book at my LTC facility says to verify placement by either ausculation or checking residual but that you only have to measure residual if there is a doctors order- any thoughts? Are a g tube and a PEG tube the same thing?

ComeClarity

ComeClarity

101 Posts

I'm not a nurse yet, but a grad LPN still studying for NCLEX. I actually was just going over this a few minutes ago in my Saunders study guide. To determine if the G-tube is still in the stomach, you can measure the pH of the aspirate. Stomach contents are acidic, so the pH should be 4 or less.

Also, why are you needing to get the aspirate into cups? You should be able to measure with the same 60cc syringe you're using to aspirate.

Do-over, ASN, RN

Specializes in CICU. 1,085 Posts

I use a graduated cylinder to measure if needed for residual - you might often have more than the 60mL of residual that the toomy will hold.

jnick31

jnick31

55 Posts

I'll have to go back and look this up again because I haven't given anything in a feeding tube in a while. I know the only true way to check placement is by pH. But I thought green indicated you were past the stomach and aspirating bile. Auscultation is how most people do it but "best practice" show that you can still hear the swoosh if it is in the lungs... I'm not sure about that one though, I haven't had any feedings go into anyones lungs yet.:yelclap:

jnick31

jnick31

55 Posts

In response to your question, the characteristics of the residual would depend on which way it migrated. if in the esophagus or lungs probably nothing unless they had GERD or fluid in the lungs. If it wen't into the duodenum your pH would change to more alkaline and that's when you'd get the green. that's how I understand it anyway, someone please correct me if I'm wrong.

misswhitney

misswhitney

503 Posts

I check for residual every time, regardless of if there is a doctor's orders or not (at our facility it is expected), especially because if they are not digesting the tube feeding, they could aspirate and it could also show other problems with their digestive system.

Turd Ferguson

Turd Ferguson

455 Posts

Are a g tube and a PEG tube the same thing?

I think G tube is usually the same as PEG tube, but both are different from an NG tube

Edited by Turd Ferguson
s

ComeClarity

ComeClarity

101 Posts

During my pediatrics rotation, I had the opportunity to administer quite a few meds and feedings through G-tubes. However, we did not pull back and aspirate as is taught in the book - our instructor taught us to put in the 60cc syringe (without the plunger in) and hold it as low as we possibly could in conjunction with the stomach. The kids at the homes we were at mostly had fundoplications due to severe GERD and could not burp up their gas, so venting with the syringe helped release the gas and give them some relief. We did flush with a prescribed amount of fluid before and after each feeding or meds, but no aspiration. Of course, this may have been the policy of the company that owned the group homes, I'm not sure.

nursegreenbean

nursegreenbean

11 Posts

I appreciate all of your responses. I feel like I should clarify some. At our facility we do not check ph, the only way to check placement is by ausculation and residual. From everything I have read it sounds like ausculation is not very reliable. When checking residual I have gotten nothing, no residual, which I take it means that the stomach is empty, I've gotten clear liquid which I think is water left over from the flushes, and then I've gotten a brownish/green that I am assuming is stomach contents. So I am confused, if you can use residual to check placement how will I know by the residual that it is know longer in the stomach? What exactly should I see?

in2ICU

in2ICU

Specializes in MICU, SICU, and transplants. Has 6 years experience. 71 Posts

-A G-tube is the same as PEG tube (Percutaneous Endoscopic Gastronomy).

-If the liquid is clear it could also be stomach acid, and the greenish color is a common finding too (in small quantities, i.e.

-The nature of the G-tube is that a dome or balloon holds the stomach wall right up against the abdomen wall.

-A G-tube should be in the right place unless the tube has migrated INTO the patient (and would be a lot shorter on the outside of the pt's abdomen). I've only heard of a G-tube coming OUT of the pt one time - and that was because he pulled it out... ouch!

-Whenever I see brown (not tan, but brown) I do a guaiac to check if there is bleeding.

-Bad colors that should make you take notice: brown, red, pink, black, coffee-grounds, or like stool. Clear, dark green or TF color are usually OK, and be mindful some odd colors like orange can come from various meds.

-As for large amounts of residual, I either use a graduated cylinder or a suction canister but it's never as neat as I'd like it to be. Always have a washcloth handy!

So these are some general guidelines - I hope this helps!

rachelgeorgina

rachelgeorgina

Specializes in .. 412 Posts

I believe a PEG tube and a gastrostomy can be slightly different. The PEG is a permanent tube extending from the stomach. The gastrostomy can be a 'button' that you need to attach a tube to in order to access it.

NAURN

NAURN

200 Posts

If I am ever concerned about placement, I get an x-ray to verify placement.

Stool should never come out of the peg... I have had residual that was so dark that I actually smelled it so see if it might be stool... (it wasn't but still) so residuals can come in all colors.

If I have more than 100 residual, I will discard it and stop feedings and consult the dr for what they want to do (hold them until further notice, recheck residuals in a certain amt of time, etc)

Guest
This topic is now closed to further replies.