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 ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.

I think there is a very high possibility of the average large bellied, supine, sedated totally dependent intubated patient aspirating stomach contents when supine.

If turning the tube feeding off for 60 secs. seems trivial, it wont seem nearly so trivial when some malpractice attny. hauls out stack after stack of accepted standards and practices that support this.....

while it may not LOGICALLY make any sense....it makes PERFECT legal sense, because,when you are being grilled on the stand with, "well, Ms. or Mr. Nurse, did you turn off the tube feeding when you turned the patient?", and you say, "uh, well no, because 1cc of tube feeding wouldn't have made anymore difference anyway".....WHO do you think is going to look BAD to a jury????

Some things are worth leaving alone....really.

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Specializes in CVICU-ICU.

You might have a point with that therory if they provide documentation that turning off a tube feed will prevent aspiration however so far I've seen people post articles here regarding the tube feeds and aspiration but I havent seen one of those saying to turn them off for a few minutes immediately before laying a person flat but lets just assume it is out there somewhere......do you document when you lay a patient supine and if so do you then document tube feeds placed on hold while repositioning? I'm willing to bet not alot of people document that so in that case......doesn't the old rule of if its not documented it isnt done apply?

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Specializes in OB, M/S, HH, Medical Imaging RN.

I think "to each his own". If you feel more comfortable stopping the feeding then continue stopping it.

If you don't agree that it's helpful and are doing it only because everyone else does then stop, but only if you want to.

Don't critize others just because their opinion is different from yours.

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I think there is a very high possibility of the average large bellied, supine, sedated totally dependent intubated patient aspirating stomach contents when supine.

If turning the tube feeding off for 60 secs. seems trivial, it wont seem nearly so trivial when some malpractice attny. hauls out stack after stack of accepted standards and practices that support this.....

while it may not LOGICALLY make any sense....it makes PERFECT legal sense, because,when you are being grilled on the stand with, "well, Ms. or Mr. Nurse, did you turn off the tube feeding when you turned the patient?", and you say, "uh, well no, because 1cc of tube feeding wouldn't have made anymore difference anyway".....WHO do you think is going to look BAD to a jury????

Some things are worth leaving alone....really.

there IS a high risk of the lgr, supine, sedated, tubed pt aspirating stomach contents....

but do you seriously think it's that 1cc of fdg that wasn't held, or more realistically, the residual in his belly?

as for your legal reference, all it would take is some expert witnesses to uphold the improbability of 1cc causing aspiration.

leslie

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Specializes in CVICU-ICU.

I can also go with the too each his own recommendation....however I have been in the position of taking care of one of my patients and I've asked for help to lift, turn and reposition and I havent turned the tube feed off because so far I think it is a crazy practice to do it the way we do it and I get coworkers reading me the riot act because of it however when I asked them to provide me with documented info as to why they cant and the response is "because its just what we do" or something else just as silly.

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Specializes in OB, M/S, HH, Medical Imaging RN.
I can also go with the too each his own recommendation....I get coworkers reading me the riot act when I asked them to provide me with documented info as to why they cant and the response is "because its just what we do" or something else just as silly.

Why does a coworker have to provide documented info as to why they do something? I think asking is a silly waste of time and asking for documented info just a ridiculous waste of time.

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Specializes in CVICU-ICU.

Dutchgirl...I think you misunderstood my entire last post.....I was saying that if my coworker wants to do it on their patient...fine by me however I chose not to do it and then they give me a hard time because I dont...so in essence they are questioning me so therefore if I can provide logically reason why I dont do it then they should provide logically reason why they do.

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Specializes in OB, M/S, HH, Medical Imaging RN.
there IS a high risk of the lgr, supine, sedated, tubed pt aspirating stomach contents....

but do you seriously think it's that 1cc of fdg that wasn't held, or more realistically, the residual in his belly?

as for your legal reference, all it would take is some expert witnesses to uphold the improbability of 1cc causing aspiration.

leslie

I totally agree leslie. The point for me is that if doesn't pose a risk either way but if a nurse feels more comfortable stopping the feeding for just that 1cc then why not let her do what she feels comfortable with? If you want to offer your opinion while you're helping to move the patient then do so but don't ask for documentation and if it falls on deaf ears then let it go. It's not worth the trouble or hurt feelings. Alot of people do things "just because" and that doesn't make it wrong.

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Specializes in OB, M/S, HH, Medical Imaging RN.
Dutchgirl...I think you misunderstood my entire last post.....I was saying that if my coworker wants to do it on their patient...fine by me however I chose not to do it and then they give me a hard time because I dont...so in essence they are questioning me so therefore if I can provide logically reason why I dont do it then they should provide logically reason why they do.

Gotcha!!!

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Specializes in CVICU-ICU.

You know I understand that whether it is turned off or not isnt that big of a deal either way....the bigger point is why nurses do things "just because" or "out of habit" without questioning or having a logical reason. We talk all the time about wanting to be treated as professionals and agrue when someone says "just a nurse"...there are many other statements but you get the idea. If we want to acheive that respect then we need to start being able to logically explain why we do what we do.

I just heard a incident that happend at another hospital close by. MD wrote a order for Cardizem IV drip at 50 mg/hr. Nurse hung it at 50 mg/hr.....never questioned it..now I realize that is alot different than the tube feed hold and he should have known that dose was not acceptable however when they asked why he didnt question his response was that the MD ordered it and he doesnt like to question docs because they get upset. Personally I think he didnt know the right dose and if he did he wouldnt have hung it and his response about thats what the doc wrote was his way of attemting to blame the doc but only he knows the truth. My point behind that story is if we dont question the little stuff we do and do it out of habit instead of logic then how are we going to gain respect when we do decide to question the larger stuff.

As it turns out the nurse in question is out of a job and the MD that wrote the order is still working with a slap on the wrist because the nurse should have realized the order was incorrect which is another thing that really makes no sense.

I agree the nurse should have known the dose however it started with the MD who wrote the wrong order....went to the pharmacy who profiled the order and then the nurse. How come the nurse is the one left holding the bag all alone? We are the final person in the list of people to provide care for our patients. MD's dont want to be questioned on orders and get upset when they are however the first time a nurse chooses not to question a order they should have the MD is the first one to blame the nurse for following a wrong order.

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kymmi- in school, we're taught rationales for everything.

you're concern has validity.

personally, i've never held fdgs when repositioning, nor was i taught to.

but i never thought to question those nurses who do hold the fdgs.

the only times i question others, is when there is considerable risk to the pt.

leslie

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Specializes in OB, M/S, HH, Medical Imaging RN.
If we want to acheive that respect then we need to start being able to logically explain why we do what we do.

I'm truly not trying to be argumenative but I don't see the comparison between "just a nurse" and being respected by explaining what we do?

I just heard a incident that happend at another hospital. MD wrote a order for Cardizem IV drip at 50 mg/hr. Nurse hung it at 50 mg/hr.....never questioned it..now I realize that is alot different than the tube feed hold and he should have known that dose was not acceptable however when they asked why he didnt question his response was that the MD ordered it and he doesnt like to question docs because they get upset.

This nurse should have lost his job, not because he made a mistake but because he proved that he's not a patient advocate by stating that he doesn't like to question docs. The fact that he didn't know the dose was unfortunate but would not be a reason enough to lose his job. Sadly doctors & pharmacists do make mistakes all the time.

MD's dont want to be questioned on orders and get upset when they are however the first time a nurse chooses not to question a order they should have the MD is the first one to blame the nurse for following a wrong order.

"a nurse chooses not to question an order" that is so so wrong. If a nurse knowingly follows a wrong order that is IMO a criminal act.

Any doctor, pharmacist or nurse worth their salt does not mind being questioned about an order. I certainly don't mind questioning them and have not had any bad experiences. If they do mind...too bad. We absolutely have to be patient advocates and questioning the doctors is a vital part of being an advocate.

I once got an order for Dilaudid 100mg/Phenergan 25mg IM Q 4hr PRN pain. It went through the pharmacy without being caught. I called the doctor. He was in surgery. I said "I don't care, I need to talk to him" the patient was in pain. Someone put the phone on speaker and I read the order back to him and said "I'm supposing that you meant Demerol not Dilaudid"? Yes, Thanks. An hour or so later he came to the floor and thanked me profusely for saving his butt.

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