60 Second Tube Feed Stop********

CritterLover, BSN, RN · Jul 5, 2007

i think the reasoning is in case the tube (dobhoff, ng, whatever) becomes disloged/migrates while the patient is being turned/moved.

as for the peg tubes, many things we do are based out of habit. it doesn't hurt anything to stop the tfs for 60 seconds, so why not stay in the habit.

Kymmi · Jul 5, 2007

You're telling me that stopping tube feeding for 60 seconds is some how going to prevent tube migration......and I'm sure you recheck tube position every time you reposition your pt.......the only accurate way to ensure tube position.........and the reason we 'break the habit' is because it is not an effective technique.....

Kymmi · Jul 5, 2007

I think that the lemmings last words were "Why not stay in the habit"

nyapa, RN · Jul 5, 2007

Please explain to me why is it that nurses fail to use any common sense or stop to think about why they do the things they do.....for example, exactly what do you accomplish by stopping tube feeding; (whether DHT, Peg Tube, G-Tube, NGT) for 60 seconds while making a pt. supine in order to reposition them in bed, then sitting them back up to resume the Tube Feeding. With a Tube Feeding rate of 60cc/hr, that would prevent 1 cc from infusing......this will hardly prevent aspiration. The Tube Feeding should be stopped 1 hour in advance, then residual should be checked prior to putting a pt in supine postion......I'm sure that is what everyone is doing.......the old phrase 'well that's what everyone else does'.......just ain't good enough.......[/quote
As I understand the maximum time you should leave a fully dependent patient before they are being turned is two hours. Wouldn't turning the feed off 1 hour beforehand mean that the patient only gets half their prescribed intake?

lsyorke, RN · Jul 5, 2007

As I understand the maximum time you should leave a fully dependent patient before they are being turned is two hours. Wouldn't turning the feed off 1 hour beforehand mean that the patient only gets half their prescribed intake?

Yup, which is why turning off for an hour is rarely done. Sometimes optimal practice and real life just don't work together. Plus if you are turning off a feeding for an hour, you're going to have to flush the tube, which adds even more fluid to the stomach...increasing the aspiration threat.

BBFRN, BSN, PhD · Jul 5, 2007

You're telling me that stopping tube feeding for 60 seconds is some how going to prevent tube migration......and I'm sure you recheck tube position every time you reposition your pt.......the only accurate way to ensure tube position.........and the reason we 'break the habit' is because it is not an effective technique.....

It doesn't prevent tube migration, but it will prevent aspiration if the tube does migrate.

Creamsoda, ASN, RN · Jul 5, 2007

I have always thought it was stupid too, and only did it because everyone else did, and if I didnt they would always ask why didnt you hold the TF? I would try to explain my logic, but they would always say thats how we always do it.

Actually yesterday, finally our educator let us know that indeed we do NOT have to hold TF for quick repositioning, only if they will be supine for a while. Finally!

Daytonite, BSN, RN · Jul 5, 2007

Please explain to me why is it that nurses fail to use any common sense or stop to think about why they do the things they do.....for example, exactly what do you accomplish by stopping tube feeding; (whether DHT, Peg Tube, G-Tube, NGT) for 60 seconds while making a pt. supine in order to reposition them in bed, then sitting them back up to resume the Tube Feeding. With a Tube Feeding rate of 60cc/hr, that would prevent 1 cc from infusing......this will hardly prevent aspiration. The Tube Feeding should be stopped 1 hour in advance, then residual should be checked prior to putting a pt in supine postion......I'm sure that is what everyone is doing.......the old phrase 'well that's what everyone else does'.......just ain't good enough.......

What I would like explained is why another nurse would be upset about the practice of colleagues when it clearly isn't doing any harm to the patient and isn't in violation of a facility policy or a nursing standard of care!

BBFRN, BSN, PhD · Jul 5, 2007

Legal Eagle Eye Newsletter for the Nursing Profession:

December 2006 Vol. 14 #12

Nasogastric Tube: Feeding

Continued While Position Still

Being Checked, Patient Dies.

"The patient was admitted to the hospital for respiratory problems. A

nasogastric tube was inserted to provide nourishment.

The tube became occluded after some period of use and had to be removed and replaced by the nursing staff. An x-ray was ordered to confirm correct placement. The x-ray showed it was not correctly

placed, that is, it extended down the trachea into the lung rather than down the esophagus into the stomach. The feeding tube was removed and replaced and another x-ray was taken. While reading of the second x-ray was still pending the nurses resumed infusing nourishment through the tube. In fact, the tube had again been inserted into the lung. Infusion of nourishment into the lung seriously compounded the patient’s respiratory problems and she

died. The Court of Appeals of Arkansas wrestled with legal technicalities involved in continuing the lawsuit against the hospital’s corporate parent after the hospital itself had settled with the family

for the consequences of the nurses’ negligence.

Lee v. Quorum Health Resources,

2006 WL 3222648 (Ark. App.,

November 8. 2006).

The allegations in the patient’s family’s lawsuit went beyond the negligence of the nurses.The lawsuit also found fault with the communication processes within the hospital between the medical and nursing staff. That would tend to indicate a more widespread problem

that a simple error or omission by the nursing staff.

COURT OF APPEALS OF ARKANSAS

November 8, 2006

jmgrn65, RN · Jul 5, 2007

Legal Eagle Eye Newsletter for the Nursing Profession:
December 2006 Vol. 14 #12
Nasogastric Tube: Feeding
Continued While Position Still
Being Checked, Patient Dies.
"The patient was admitted to the hospital for respiratory problems. A
nasogastric tube was inserted to provide nourishment.
The tube became occluded after some period of use and had to be removed and replaced by the nursing staff. An x-ray was ordered to confirm correct placement. The x-ray showed it was not correctly
placed, that is, it extended down the trachea into the lung rather than down the esophagus into the stomach. The feeding tube was removed and replaced and another x-ray was taken. While reading of the second x-ray was still pending the nurses resumed infusing nourishment through the tube. In fact, the tube had again been inserted into the lung. Infusion of nourishment into the lung seriously compounded the patient's respiratory problems and she
died. The Court of Appeals of Arkansas wrestled with legal technicalities involved in continuing the lawsuit against the hospital's corporate parent after the hospital itself had settled with the family
for the consequences of the nurses' negligence.
Lee v. Quorum Health Resources,
2006 WL 3222648 (Ark. App.,
November 8. 2006).
The allegations in the patient's family's lawsuit went beyond the negligence of the nurses.The lawsuit also found fault with the communication processes within the hospital between the medical and nursing staff. That would tend to indicate a more widespread problem
that a simple error or omission by the nursing staff.
COURT OF APPEALS OF ARKANSAS
November 8, 2006

Very scary, and proves why you should wait until you have results of the X-ray. :nono:

However it has nothing to do with what the op is upset about.

What I don't understand is WHY the op is so angry.:uhoh21:

BBFRN, BSN, PhD · Jul 5, 2007

PREVENTING RESPIRATORY COMPLICATIONS

OF TUBE FEEDINGS: EVIDENCE-BASED PRACTICE

By Norma A. Metheny, RN, PhD. From Saint Louis University, St. Louis, Mo.

DISTINGUISHED RESEARCH LECTURE

Presented May 22, 2006, at the AACN National Teaching Institute, Anaheim, Calif.

"The most dreaded complication of tube feedings is tracheobronchial aspiration of gastric contents.

Strong evidence indicates that most critically ill tube-fed patients receiving mechanical ventilation aspirate

gastric contents at least once during their early days of tube feeding. Those who aspirate frequently

are about 4 times more likely to have pneumonia develop than are those who aspirate infrequently.

Although a patient’s illness might not be modifiable, some risk factors for aspiration can be controlled;

among these are malpositioned feeding tubes, improper feeding site, large gastric volume, and supine

position. A review of current research-based information to support modification of these risk factors is

provided. (American Journal of Critical Care. 2006;15:360-369)"

"McClave et al3 found that 30 of 40 gastric-fed, critically ill patients had at least 1 microaspiration during the early course of the patients’ tube feedings."

"Even small aspirations of gastric acid can injure the pulmonary

capillaries and cause exudation of protein rich fluid."

"Pulmonary injury due to aspirated enteral formula most likely varies according to the osmolality and other characteristics of the formula. After the initial lung injury caused by aspiration, microorganisms typically present in gastric contents increase the probability of aspiration-related pneumonia."

"Supine Position

Evidence That the Supine Position Increases Aspiration Investigators78-80 who used radiolabeled enteral formula showed that aspiration of gastric contents occurs to a significantly greater degree when patients are in a supine position than when in a semirecumbent (45º backrest elevation) position.

A low head-of-bed position was also identified as a significant risk factor for aspiration in a study4 of 360 critically ill tube-fed patients receiving mechanical ventilation who were followed up for a period of 3 days. Almost 62% (n = 223) of the 360 patients had mean head-of-bed elevations less than 30º; these

patients aspirated significantly more often than did patients with mean head-of-bed elevations of 30º or more (P = .02). Almost 94% (n = 338) of the 360 patients had mean head-of-bed elevations less than 40º; these patients also aspirated more frequently than did patients who had mean head-of-bed elevations of 40º or more (P=.02)."

This is evidence-based practice. Hopefully, it explains why we turn off the tube feedings- especially in our intubated patients. They have higher rates of aspiration PNA than other patient populations.