Withheld meds

[demo24]

Hi all,

I was just curious about the legality of a particular situation. One morning I come into work and the night shift nurse leaves a note stating that the pts peg tube was clogged and to call for a GI consult which I did. The problem being is that i was unable to pass meds that were to be administered via peg due to the clogging of the peg tube. I called the GI dr twice to come and hopefully look at it in hopes of fixing it, but no response all day. I at some point had to state that meds and feeding were held due to no access pretty much all day. The pt still remained stable and i was able to give iv meds, but in the mar i had no choice but to put med not given via peg due to no access. I also wrote in my notes that the dr was notified twice, and no response. Is this a red flag and considered a med error and will and can there be legality issues because of this? I guess what im asking is did i chart properly? Thank you

[loriangel14, RN]

We use a drug called Pancrelipase to clear blocked tubes. It is a pancreatic enzyme.

i would have tried to unclog the tube if no one responded after that much time.

[Whispera, MSN, RN]

I'm unclear if the GI doc was the doc who prescribed the meds. If he wasn't the one who prescribed them, did you notify the doc who did prescribe them? If so, other than using declogger, you did all you could, I think.

[loriangel14, RN]

Did you try using Coke?

[demo24]

It was the primary dr who prescribed the meds and the primary doc just told me to call the gi. He stated not to give anything via piv and if the bp went up to do a nitro 2 inch patch and that should help it. But I did not even see an order for anti hypertensives.

[demo24]

No I did not.

[0.adamantite]

We have a feeding tube declogging protocol. Otherwise I would have tried harder to get in touch the MD. The call centers I talk to have the MD's cell phone number and if they do not answer their pager in 30-40 minutes you can call back and they will patch you through to the MD's direct line. All they need to do is put in an order to replace the tube.

[amzyRN]

Coke is supposed to work really great. I've had a patient with a clogged g-tube before and one of the other nurses used some coke to de clog it. Sometimes a patient will have to go to IR. It's just a matter of experience with these types of things, no need to feel bad. The patient survived and missed a few doses of medications and the MD was aware of this. Really critical meds can be given IV. Try coke next time though or using a smaller syringe with a smaller diameter to flush the tube.

[canigraduate]

Coke is supposed to work really great. I've had a patient with a clogged g-tube before and one of the other nurses used some coke to de clog it. Sometimes a patient will have to go to IR. It's just a matter of experience with these types of things, no need to feel bad. The patient survived and missed a few doses of medications and the MD was aware of this. Really critical meds can be given IV. Try coke next time though or using a smaller syringe with a smaller diameter to flush the tube.

Please don't follow this advice. Sorry, amzyRN. Follow your facilities policy and procedure. If they have a standard for declogging, use that. It is best to use manufacturer suggestions. It is a bad idea to use unapproved methods to declog a PEG as they can compromise the integrity of the tube, even with something as innocuous as Coke (which I use to clean the terminals of my car battery - it is very corrosive). Also, using a smaller bore syringe can backfire and blow out the side of the tube above the clog, necessitating the replacement of the whole apparatus.

You did the best you could and you documented it. The only things I would suggest are:

1) Try aspirating back the clog. Sometimes this works better than trying to push it through.

2) Manually palpate the tube and see if you can feel the clog and try to "mash it out" GENTLY.

3) Instill warm (not hot) water while agitating it and letting it dwell, then trying to aspirate back the clog

4) Page the doc q30 min until he returns the call.

[demo24]

Thank you all for your responses well appreciated..

[morte, LPN, LVN]

if you did not get one, you needed a specific order from the PCP to hold ALL meds that would ordinarily be given through the feeding tube, and the feeding, if there was one.

[Tenebrae, BSN, RN]

60mls normal coke works wonders in declogging a PEG or PEJ

[Here.I.Stand, BSN, RN]

Could be against policy to use Coke, though.