Tube Feeding on Hold

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Do you think that it is appropriate critical thinking to turn off tube feeding on a patient that is at risk of immediate coding because of deteriorating vital sign changes? Patient would be at risk for aspiration if chest compressions were performed and should you have to get a doctors order to turn off tube feedings?

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Specializes in Critical Care.

It all depends. Where is the distal end of the tube located? Stomach? post pyloric? Regardless, the slow rate of the TF will have little to no bearing on acute decompensation unless you have some evidence that it is directly related to TF such as ETT suction or trach suction. Which vital signs are you referring to?

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Distal end is in stomach. The tube feeding are not the cause of VS deteriorating. SBP in 80's, DBP in 40's, map vacillating 60-64. heart rate 50's. patient is septic, pulmonary edema, and third spacing, trach on vent, concerns for having to start levophed. These vitals have changed from previously stable VS. My concern is if the patient codes and we proceed with chest compressions then doesn't the tube feeding place patient at a higher risk of aspiration during compressions? So, shouldn't the feeding be turned off temporarily until stability is maintained?

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Specializes in Stepdown . Telemetry.

It wouldn't hurt the patient to turn off the feeding temporarily. So you might as well, right?

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Specializes in Critical Care.
Distal end is in stomach. The tube feeding are not the cause of VS deteriorating. SBP in 80's, DBP in 40's, map vacillating 60-64. heart rate 50's. patient is septic, pulmonary edema, and third spacing, trach on vent, concerns for having to start levophed. These vitals have changed from previously stable VS. My concern is if the patient codes and we proceed with chest compressions then doesn't the tube feeding place patient at a higher risk of aspiration during compressions? So, shouldn't the feeding be turned off temporarily until stability is maintained?

If it comes to the point of chest compressions, tube feedings are the least of your concern.

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Specializes in Critical Care.

If we routinely didn't feed anybody because they had a HR in the 50's and/or MAP 60-65 then a lot of people wouldn't get tube feedings, which would likely do more harm than keeping them going. If they really are just about to code then pausing the tube feedings won't make much difference, normal gastric volume can be 250 mls or more, so keeping that few mls that they'll get before coding won't make any difference.

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Specializes in Critical care.

Not a reason I'd hold feeding. As already said, many of my critical pts would never be fed if such criteria was used.

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Specializes in Reproductive & Public Health.

Agreed. I am not in critical care, but you could be pausing and restarting that pump all day if you are doing it any time a patient looks a little green around the gills. A bolus feeding? Sure. But otherwise, I don't think it is a helpful intervention, and you run the risk of forgetting to turn it back on, or pausing it so frequently that the patient doesn't get enough fluid/calories to support their already compromised state.

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Specializes in ICU.

I wouldn't turn tube feeds off for those vitals, especially without any other indications. Those vitals look great, especially if you haven't started pressors yet.

Now, if you have a rock solid indication that the patient is going to code - SpO2 persistently in the 60-70s despite APRV/Flolan/nitric, sudden distinct changes to the heart rhythm (sudden widening of the QRS is what I'm thinking about here), a MAP you can't get out of the 40s with four or five pressors going, or the heart rate suddenly in the 30s/40s when it had been running well over 60 with no apparent reason to drop - yes, I stop the tube feeds. It's not going to make much of a difference anyway, but I do.

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Specializes in Cardiac/Transplant ICU, Critical Care.

Whether the patient is vented or not, if a patient's condition is rapidly deteriorating and you have time before you actually initiate ACLS, ABSOLUTELY turn it off. You can always restart it if it is appropriate and safe for the patient after things have settled down. It depends on your hospital protocol whether or not you need a MD's order to DC TFs, you can probably just chalk it up to nursing judgment and call it a day.

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If it comes to the point of chest compressions, tube feedings are the least of your concern.

Yeah, that's what I was thinking. If your patient's dead, aspiration isn't going to matter.

I would probably automatically turn the pump off when laying the patient down to do compressions, though.

Those vitals aren't super bad. Sounds like you need to get the fluid back into the vasculature, more than anything. The TF might help with the 'lyte balance and some proteins to get things back on the right track.

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