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

Nurses General Nursing

Published

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.......

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

Let me know if you need more studies done on this. I have access to an evidence-based practice database.

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

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

I don't understand why she is so angry, either.

The articles didn't specify which type of tube was used. An ng tube certainly would have a higher risk for aspiration dangers, if placement isn't verified by x-ray. Peg tubes, on the other hand, are held to the stomach wall by the balloon or ring, with much less chance of migration. Tubes placed in the jejunum are also much less likely to be a cause of aspiration because of placement. The most frequent problem I have seen with j-tubes is that they come out of the patient. Neither the PEG or the J has the opportunity to be in proximity to the lung as the NG does. Aspiration of stomach contents would be possible if the patient were vomiting, but that would be the case even if a tube isn't used at all. Just my $0.02

I don't understand why she is so angry, either.

:yeahthat:

Just another thought that I had was is that shutting it off while doing repositioning just in case it would get it caught and it would pull out of the tube. Then you do not have tube feed running all over the place. Maybe that is why they shut it off.

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
The articles didn't specify which type of tube was used. An ng tube certainly would have a higher risk for aspiration dangers, if placement isn't verified by x-ray. Peg tubes, on the other hand, are held to the stomach wall by the balloon or ring, with much less chance of migration. Tubes placed in the jejunum are also much less likely to be a cause of aspiration because of placement. The most frequent problem I have seen with j-tubes is that they come out of the patient. Neither the PEG or the J has the opportunity to be in proximity to the lung as the NG does. Aspiration of stomach contents would be possible if the patient were vomiting, but that would be the case even if a tube isn't used at all. Just my $0.02

I'm sorry- the second article was r/t DHTs and NGs with regard to migration. The crux of my point in posting that article was that migration is only one of the reasons we shut off TFs during repositioning. There are other factors involved in asp. PNA, such as gastric emptying problems, TF intolerance, pH of the solution, etc.

It (as well as other studies) has shown that micro-aspiration can also be problematic, thus debunking the "it is only a small amount that can be aspirated during repositioning" argument.

I believe J-tubes have a higher rate of intolerance (thus gastric reflux, thus aspiration) than G-tubes. I may be wrong, but will try to research where I saw that article if need be (maybe someone else has that info).

It was a long article, but I put the author, etc. up so you can search for it and read it for yourself. The article itself does spell out the problems with each type of tube, but I didn't copy the entire thing.

There are numerous recent studies done on TF aspiration and micro-aspiration.

Specializes in MSICU starting PICU.

I agree that this is an interesting topic to discuss, but geez no need to get your panties in a bunch LOL thanks for the evidence based practice articles :-) I have always wondered about this practice as well.

Specializes in Neuro Floor & now Surg/Trauma/Neuro ICU.

I think you are all missing the point. The OP did not say that it is wrong to stop the TF. The point was that stopping it at the time you put the patient in a supine position to reposition leaves him with a full stomach of tube feeding to aspirate. The OP suggested that it makes more sense to stop the feeding ahead of time to allow some of the stomach contents to pass into the duodenum, thus leaving very little in the stomach for the patient to aspirate.

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Yeah, and (like someone else said), if you have to stop the TF for an hour before you reposition, and you reposition every 2 hours, then the pt only gets 12 hours of tf a day (instead of the 24 they are supposed to get if they are continuous). What I don't get is the 60 seconds...our pumps hold for 5 min before they beep, and often when we're repositioning or bathing the pt, it beeps before we're done and we have to reset the timer.

And I agree that any tube that passes the LES is going to have an inherently higher risk for aspiration...if that sphincter isn't all the way closed, or if it's weak from having the tube there, it seems you'd be more likely to have stuff going back up the esophagus. Or, of course, like someone else said, if the pt is vomiting, you're going to have a huge risk for aspiration.

I can see that this is a good topic for discussion, but I don't get why the op wa so aggressive about it...almost sounded angry in the first post!

Specializes in Med/Surg, Ortho.

SInce most patients with tubes need repositioned at minimum of every 2 hours to stop a tube feeding for any more than 5 min. prior to reposition would drastically change the total calorie intake for that patient over the course of the day/week. Rates are figured by the doctor for calorie/day consumption to keep the patient as healthy as possible. So turning off for any period of time other than a few 5 min or less would change the patients calorie intake.

The tube is more likely to be dislodged while repositioning the patient than while the patient is still. You may or may not notice that position of the tube has changed, and most nurses probably do not recheck placement after repositioning the patient. However, in the case that the tube has obviously changed position, it will have been beneficial to have stopped the feeding and perhaps prevent aspiration.

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!

Because that's how nursing practice evolves and becomes more effective.

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