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.......

am i being naive or aren't tf pts always in a high fowler's?

my repositioning them is giving them a scoot upwards, maintaining the fowler's position.

so where would aspiration come in?

it defies the logic of gravity.

i know it's different when vented, but the majority of my pts are not.

leslie

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
am i being naive or aren't tf pts always in a high fowler's?

my repositioning them is giving them a scoot upwards, maintaining the fowler's position.

so where would aspiration come in?

it defies the logic of gravity.

i know it's different when vented, but the majority of my pts are not.

leslie

Aspiration comes in when you have to lay the HOB flat to move the pt up, they have to be in reverse Tburg r/t spine injury, etc. Anything

Specializes in CVICU-ICU.

Ok....let me clarify....I am not angry about anything however I have had this discussion with others at work and I cant seem to find a answer to why this practice is done (turning off the feed for a minute or two while repositioning). I think there are alot of things we do as nurses because its what everyone else does however when asked for a justification as to why no one can give one other than that.

I do not turn off my feedings for a hour prior to repositioning actually I do not turn them off at all and my reasoning is this----if you are attempting to prevent aspiration then turning it off for that long will not prevent stomach contents from reguratating so in therory the only way to prevent that from happening is to aspirate and check residual prior to turning or turn off feeds and let the stomach empty which we know is not logical. IF the point of turning them off is to prevent aspiration in the event that the tube migrates then it is imperative that we check placement after the turn before we turn the feeds back on in order to be sure that the tube is in place and I can assure you that I've seen my coworkers turn the feeds off and do whatever needed done then sit the patient back up to at least at 45 degree angle and NOT check tube placement so that blows that reasoning out of the water also.

I think alot of things we do out of habit need to be questioned in order to make us think more and become respected as professionals which is what everyone is always saying that they feel they lack however when asked a simple reason as to why they do something the response is not backed by reason only by a response because of habit or _______ (fill in the blank).

I realize this is a minor issue however I think its better to start questioning the minor things we do before tackling the major ones.

I also wonder why people that have a functioning A-line that correlates with the NIBP continue to set the NIBP off frequently when titrating drips..............isnt that what the Aline is for? Why use the NIBP if you know that the Aline works?

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Ok....let me clarify....I am not angry about anything however I have had this discussion with others at work and I cant seem to find a answer to why this practice is done (turning off the feed for a minute or two while repositioning). I think there are alot of things we do as nurses because its what everyone else does however when asked for a justification as to why no one can give one other than that.

I do not turn off my feedings for a hour prior to repositioning actually I do not turn them off at all and my reasoning is this----if you are attempting to prevent aspiration then turning it off for that long will not prevent stomach contents from reguratating so in therory the only way to prevent that from happening is to aspirate and check residual prior to turning or turn off feeds and let the stomach empty which we know is not logical. IF the point of turning them off is to prevent aspiration in the event that the tube migrates then it is imperative that we check placement after the turn before we turn the feeds back on in order to be sure that the tube is in place and I can assure you that I've seen my coworkers turn the feeds off and do whatever needed done then sit the patient back up to at least at 45 degree angle and NOT check tube placement so that blows that reasoning out of the water also.

I think alot of things we do out of habit need to be questioned in order to make us think more and become respected as professionals which is what everyone is always saying that they feel they lack however when asked a simple reason as to why they do something the response is not backed by reason only by a response because of habit or _______ (fill in the blank).

I realize this is a minor issue however I think its better to start questioning the minor things we do before tackling the major ones.

I also wonder why people that have a functioning A-line that correlates with the NIBP continue to set the NIBP off frequently when titrating drips..............isnt that what the Aline is for? Why use the NIBP if you know that the Aline works?

Thanks for the clarification.

On the NIBP/ A Line thing- I do set my NIBP to go off Q1 hr when titrating drips, so I can verify hourly that my A Line is indeed functioning properly. I want 2 correlating BPs from different sources so I know I am titrating to a true BP. I am on CCU, and we titrate multiple pressors on a regular basis, though.

Specializes in CVICU-ICU.

I can understand wanting a accurate b/p esp when titrating drips on a critical patient...I work in CVICU and we do alot of critical titration. I check my aline pressures q 4 hours providing I have a accurate waveform on my aline and my aline and NIBP cuff pressures correlate. I have seen however many people not titrating drips and they have accurate alines with adequate waveforms setting the NIBP off every hour or more. Some might once again say so what and why would I be concerned however have you ever had those NIBP cuffs on? They get very tight and hurt at times and also people with edema in the arms or the elderly and their fragile skin can be sensitive to the NIBP going off so frequently which isnt really necessary.

I've never managed to reposition a pt in 60 seconds....

Specializes in MSICU starting PICU.

kymmi thanks for the clarification, it all makes sense to me, being a new nurse i try to ask the whys as much as possible and i tend to get the same answers the because of protocol ect. but never get to researching protocol on the simple things like turning TF off for reposition ect. I also find it insane to be correlating the a-line and nbp hourly, i do it as needed, starting a pressor, drastic change in a-line or urine output, but these poor patients have enough monitoring devices and uncomfortable hospital necessities, why continue to torture them with nbp every hour, the a-line is a beautiful thing, i understand there are multiple factors that can affect the reading, but there are also factors that can affect the nbp

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
I have seen however many people not titrating drips and they have accurate alines with adequate waveforms setting the NIBP off every hour or more. Some might once again say so what and why would I be concerned however have you ever had those NIBP cuffs on? They get very tight and hurt at times and also people with edema in the arms or the elderly and their fragile skin can be sensitive to the NIBP going off so frequently which isnt really necessary.

Yes, in cases such as the above, I would probably change my NIBP to Q4 hrs also.

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
I've never managed to reposition a pt in 60 seconds....

Same here. :chuckle

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
I also find it insane to be correlating the a-line and nbp hourly, i do it as needed, starting a pressor, drastic change in a-line or urine output, but these poor patients have enough monitoring devices and uncomfortable hospital necessities, why continue to torture them with nbp every hour, the a-line is a beautiful thing, i understand there are multiple factors that can affect the reading, but there are also factors that can affect the nbp

Yes, it depends on multiple factors. But, If I am going to decrease monitoring capabilities on a patient, I better darn well make sure I have a good reason for doing so- with the evidence-based practice guidelines to back it up.

Specializes in MSICU starting PICU.

I believe at my particular hospital, our protocol says that every day at 8 am the a-line and nbp need to be correlated and any difference can be reported and discussed with m.d. and per pt condition to determine if more frequent monitoring is necessary. I have had a physician tell me to pull the a-line as the pt was transferable, as in could go to the floor. the a-line was showing a pressure 40 points higher than the nbp even after troubleshooting, his theory was, "The pt won't be going on the floor with an a-line nor will he be at home with the a-line" but when they are super sick i have no trouble torturing their arms if it means ensuring their kidneys are being perfused ect

Specializes in CVICU-ICU.

Nursenpkn---I understand what you are saying so let me ask if you decide to monitor both the aline and the NIBP and you do have a large difference in the readings however you are sure your Aline is level/zeroed and you have a perfect waveform......than what number are you treating.......

Lets say your patients mental status is normal, urine output is normal, no signs that he's not perfusing, good cap. refill, good color in his extremities, Aline pressure is reading 120/80 however NIBP has a reading of 80 systolic....you recheck the NIBP and its still reading in the 80's systolic........what pressure are you going to go by to titrate drips?

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