Vomiting coffee ground colored vomitus with PEG tube in place for 11 months

[iediethrlevingston]

Patient has had a PEG tube for 11 months. She began vomiting coffee-ground colored vomitus about 3 weeks ago. She was vomiting some every day. One day she had at least 120 cc of coffee-ground colored residual. She had had no bowel movements for 4 to 5 days. Should the coffee-ground colored residual be pushed back through the PEG tube?

[Jolie, BSN]

Why was the PEG tube inserted in the first place?

I don't know how the patient would benefit from having old, dried blood returned to her via a PEG tube, but I don't think that's the most pressing issue, either.

Has she been examined by her physician or had any kind of evaluation or testing to determine why she is experiencing these symptoms (vomiting, absence of BM) after having a PEG tube in place uneventfully for 11 months?

Has anyone considered the possibility of a partial obstruction?

[UM Review RN, ASN, RN]

And no one has called the doc yet?

That's not good.

[caliotter3]

I had a peds patient do this in the middle of the night and then the blood became frank. We took the patient to the ER and after several hours, they said well, ok. That was it. Nothing.

[leslie :-D]

jolie, partial obstxn was my first thought.

kind of confirmed w/op stating no bm x 4-5 days.

i'm thinking there has likely been a chronic problem w/bm's.

either way, this warrants a stat call to the doc.

and, you may want to give a suppository/enema stat as well.:icon_roll

leslie

[Dr. Tammy, FNP/GNP-C]

Surgeon referral, like yesterday.

[Virgo_RN, BSN, RN]

Patient has had a PEG tube for 11 months. She began vomiting coffee-ground colored vomitus about 3 weeks ago. She was vomiting some every day. One day she had at least 120 cc of coffee-ground colored residual.

This is a sign of an upper GI bleed and should be reported to the doctor. An endoscopy would be appropriate to diagnose and potentially treat an UGIB.

She had had no bowel movements for 4 to 5 days.

Is she getting enough free H2O? Does she have any abdominal distention, and what do her bowel tones sound like? What kind of bowel care regimen is she on?

Should the coffee-ground colored residual be pushed back through the PEG tube?

This may not be the correct answer, but I would, so long as she does not have liver disease. Fluid and electrolyte imbalances can be caused by loss of gastric contents. The coffee ground material is simply her own blood that has been turned brown by her own gastric acid. It is not infectious material.

[muffin7]

This sounds like an upper gi bleed, but also an obstruction.

[nminodob]

One thing in addition to what everyone else has said - aside from the emesis which is a big issue, it has been my experience that tube feedings typically cause loose stools - so lack of a BM is a real red flag. We never let a pt go more than 3 days w/o a BM and not inform the docs of it. As for re-instilling the emesis, I wouldn't - in fact I would suggest that ALL tube feedings be held until the docs check the pt out

[BabyLady, BSN, RN]

You return gastric juices or nutrients back into the stomach.

Blood would not count.

[nerdtonurse?, BSN, RN]

Did you check for bowel sounds? Distention? Pain? Listen to the lung fields? If the person has a peg and they're puking, they could aspirate big time, since most people get pegs because they can't protect their airway during swallowing.

Illeus is my bet.

Stop reading AllNurses and call the freakin' doctor.

[Sunflowerinsc, ADN, RN]

Vomiting for 3 weeks and no BM for more than 72 hours. WOW!

Keep pt NPO, check for BS, distention, check for impaction, check stool

for occult blood,check H&H. Would need a CBC and CMP if vomiting that long. History of bleeding ulcers, had abd. surgery before ?

Lung sounds, temp ,vomiting causes aspiration.

Get the facts together and call the Doc .

I would not put coffee ground emesis (old blood) back into a belly that

might be full of blood.