When to stop a tube feed

Hello Eveyone-I have been asked to give an inservice to our nurses (I am a registered dietitian working with Vista Care Hospice) on common problems and solutions with enteral feeds. We have many patients that come on to our service with PEGs that are still in use. The most common "problem" I don't really have an answer for is when to stop. What are the signs and symptoms that they should be looking out for? Many times it seems that these poor patients are having high residuals and just not tolerating and no matter what changes are made they still will not tolerate. I finally tell the RN just to stop and the patients seem calmer and pass in the next several days. Am I doing the right thing? Does anyone have guidelines that they follow?

Thanks, Beth Melvin, RD, LD

You are absolutely doing the right thing. If the residuals are that high, then their motility is grossly impaired. A nurse should be listening for bowel sounds and see how active or inactive they are. Furthermore, when people are that sick, these fdgs just make them feel much worse. The guidelines I go by is how advanced in their disease process they are- a nurse can tell just by doing their own assessments and by asking the pt if they want anything to eat. With g-tubes, ask them if they're feeling nauseous; is the belly getting distended? Are they actually vomiting. When someone has cancer, if they want to eat, it's usually 1-2 bites of something and that's it. Just as in IV fluids, it actually makes the patient feel worse, as their body is shutting down and doesn't function the way a healthy person would. Hope this was helpful.

Leslie