TUBE: SYRINGE FEEDING (G-Tube)

Nursing & Wellness Program SPECIALIZED PHYSICAL HEALTH CARE SERVICES GASTROSTOMY BUTTON/TUBE: SYRINGE FEEDING (G-Tube) THIS PROCEDURE SHALL BE PERFOR...
Author: Byron Norman
9 downloads 0 Views 354KB Size
Nursing & Wellness Program

SPECIALIZED PHYSICAL HEALTH CARE SERVICES GASTROSTOMY BUTTON/TUBE: SYRINGE FEEDING (G-Tube) THIS PROCEDURE SHALL BE PERFORMED BY THE CREDENTIALED SCHOOL NURSE IN ACCORDANCE WITH PHYSICIAN’S ORDERS. A STAFF MEMBER MAY PERFORM THIS PROCEDURE UNDER THE SUPERVISION OF THE CREDENTIALED SCHOOL NURSE OR SPECIAL EDUCATION ITINERANT NURSE AFTER THEY HAVE BEEN INSERVICED AND CAN DEMONSTRATE COMPETENCY IN PERFORMING THE PROCEDURE. THIS PROCEDURE WILL BE MONITORED AND DOCUMENTED BY A CREDENTIALED SCHOOL NURSE.

I.

GENERAL INFORMATION A. The following forms must be in place to enable the procedure to be performed at school. 1. A signed Physician’s Authorization for Gastrostomy Procedure. 2. A signed Parent Request for Having Specialized Health Care Services Provided is required. 3. A Physician’s Recommendation for Medication completed by the physician and signed by the parent, if medication is to be given in conjunction with this procedure.

II.

DEFINITION An opening is surgically created from the abdominal wall into the stomach. A tube or button is placed through this opening to provide hydration, feeding or administration of medication.

Rev 8-12 –DP – SPHCS

Page 1 of 7 Gastrostomy Tube (Syringe Feeding)

III.

GENERAL INFORMATION A. This procedure requires authorization by a physician. The service must be reauthorized yearly by the prescribing physician and the parent. Authorization must include the following: 1. 2. 3. 4. 5. 6. 7. 8.

The name of the prescribed feeding and/or medication. Amount and/or dose. Scheduled time for administration at school. Rate/flow time, number of gtts/min Amount of water for flushing. Protocol to follow if tube or button dislodges. (Refer to appropriate SPHCS procedure). Gastrostomy information sheet. Any changes in the procedures require a physician’s written order.

B. The parent will provide prescribed feeding and/or medications and any necessary equipment for performing the procedure at school. C. Feeding by mouth will be done only if ordered by the prescribing physician. If oral feedings are contraindicated, this situation should be documented. D. The parent will be responsible for adequately securing the tube with an appropriate dressing to prevent inadvertent removal or contamination unless the physician has requested no dressing. Under the direction of the prescribing physician, the parent is responsible for maintaining an adequately functioning and properly placed gastrostomy tube. IV.

GUIDELINES A. Purpose To provide adequate fluids, nutrition and/or medications for a person who is unable to swallow safely. B. Equipment (*Parent to provide) 1. 2. 3. 4. 5. 6.

* Syringe 60cc * Prescribed feeding and/or medication at room temperature * Container for water and formula * Catheter plug, clamp or rubber band * If using a button, the proper extension tube must be provided * Decompression tube, if ordered. (For gastrostomy button only). DO NOT USE THE PROBE, THIS MAY INJURE THE STOMACH WALL. 7. Stand or hook to suspend the substance for feeding. 8. Gloves 9. * Extra appropriate size catheter to be used to maintain ostomy. NOTE: Parent/guardian should provide the appropriate catheter to be used to maintain patency of gastrostomy opening should the tube/button become dislodged. Refer to appropriate SPHCS procedures. Rev 8-12 –DP – SPHCS

Page 2 of 7 Gastrostomy Tube (Syringe Feeding)

V.

PROCEDURE Essential Steps

Key Points and Precautions

A. Prepare Student 1. Explain procedure to student.

Use developmentally appropriate communication.

2. Provide privacy for student during feeding if indicated. 3. Place the student in a semi-sitting position or in a position specified by the physician to facilitate digestion and to prevent vomiting. Arrange the student’s clothing to expose the gastrostomy tube/button site for continual monitoring during the feeding.

ELEVATION OF HEAD HELPS PREVENT VOMITING AND ASPIRATION OF FEEDING INTO LUNGS.

4. Position student on right side. (MOST DESIRED POSITION.)

Report any unusual observation to site nurse before feeding begins. This position facilitates passage of stomach contents into the small bowel and aids digestion.

5. Place in supine position when unable to position on right side.

IF STUDENT’S HEAD IS NOT ELEVATED, THERE IS A DANGER OF ASPIRATION AND REGURGITATION INTO THE LUNGS.

6. Position on the left side when unable to use other positions. (THIS IS THE LEAST PREFERRED POSITON.)

Use of this procedure can create a pooling of the feeding in the stomach.

7. Wash hands

HAND WASHING IS THE MOST IMPORTANT STEP IN PREVENTION OF INFECTION.

8. Assemble equipment and supplies. 9. Check expiration date on all types of formula. 10. Add any required additional food or medication as ordered, shake the liquid for feeding if required, and measure prescribed amount in a clean container.

Rev 8-12 –DP – SPHCS

The substance to be fed should be at room temperature. Refrigerate the formula after opening the container. Discard outdated formula and formula that has been opened after 48 hours.

Page 3 of 7 Gastrostomy Tube (Syringe Feeding)

Essential Steps

Key Points and Precautions

11. Measure the required amount of water in another container for flushing the tube at the end of the feeding. 12. Prepare medications and administer them as ordered. 13. Proceed to Step 22 if the button is not used. (Button Procedure Steps 14 – 21) 14. Attach open syringe to the decompression tubing or adapter tubing to vent as needed.

Venting may be optional, depending on age, size and tolerance.

15. Put on gloves. 16. Unplug the button. Introduce the decompression tube into the button (if ordered) to check for gastric contents (this step ensures patency).

A forceful outflow of formula filling the syringe indicates the tube is in place and the stomach is still full of previous feeding. If forceful outflow occurs, return fluid to stomach and hold feeding for one hour.

17. Remove decompression tube. The use of the decompression extension tube is not recommended for feeding as it weakens the one way valve. 18. Attach the extension tube (for feeding) to the syringe. Pour formula into syringe then unclamp tubing allowing formula to clear air from the line. Reclamp tubing. 19. Unplug the button. Stabilize the button with one hand while attaching the appropriate tubing to the button opening. Unclamp the tubing. Hold syringe 3 to 6 inches (8 to 15 cm) above the stomach level and allow the formula to enter the stomach.

Rev 8-12 –DP – SPHCS

Give the formula slowly (over a 20 to 30 minute period) to reduce chances of regurgitation or distention. If the button malfunctions or if bleeding or drainage occurs, inform the school nurse, SEIN, or parent. Infants should be encouraged to use a pacifier during the feeding to stimulate sucking, improve oral function, and to facilitate absorption of nutrients.

Page 4 of 7 Gastrostomy Tube (Syringe Feeding)

Essential Steps

Key Points and Precautions

20. After the feeding has been completed, flush with the prescribed amount of water and detach the tubing from button opening. Plug the button.

Watch for gagging, sweating, restlessness, color changes, or distended abdomen.

21. Stop immediately if signs of regurgitation occur. Detach the tubing from the bottom and introduce the decompression tube, if ordered, to decompress the stomach.

Inform the school nurse or SEIN if no gas or gastric contents are obtained.

Decompression tubing is not needed when using a MicKey. To decompress the stomach when a child has a MicKey, attach the extension set with a syringe attached to allow fluid and gas to escape.

(Procedure Steps 22 – 31) 22. Attach syringe barrel (without plunger) to the G-Tube. Unclamp and lower the barrel until gas is released or gastric contents are visualized. This ensures proper tube placement in the stomach and checks patency of the tube. 23. If scant or no back flow, gently push the G-Tube inward about 1 inch and twirl it at least one complete turn.

G-Tubes that are about to come out of the stoma will now be prevented from doing so. G-Tubes that are in the sphincter between the stomach and small bowel will NOT twirl.

24. DO NOT TUG AT THE G-TUBE as it causes accidental dislodgment of the GTube.

Twirling will prevent formation of undesirable adhesions. Gagging is also a sign of the GTube being in the pyloric sphincter.

25. Clamp the tubing. 26. Pour the formula or medications into the syringe barrel. 27. Unclamp the tube and hold the syringe 3 to 6 inches (8 to 15 cm) above stomach level.

Rev 8-12 –DP – SPHCS

The flow is regulated by gravity. Give the formula slowly (give over a 20 to 30 minute period) to reduce chances or regurgitation or distention. If needed, occasionally hold the syringe below the level of the stomach to allow any gas buildup to escape. If the formula will not go in by gravity, try rotating the tube slightly or squeezing the length of the tube. Notify the nurse if the tube cannot be cleared by any of these means. DO NOT USE THE PLUNGER TO FORCE THE TUBE TO CLEAR. Page 5 of 7 Gastrostomy Tube (Syringe Feeding)

Essential Steps

Key Points and Precautions

28. Keep adding formula and/or medications without introducing air. After the feeding has been completed, let the formula drain to the bottom of the syringe and clamp the tube.

Observe the student closely. If signs of the regurgitation occur, stop immediately. Leave the tube open to relieve pressure and allow the formula to drain out. Notify the school nurse and document the incident.

29. Flush the gastrostomy tube with the prescribed amount of water to prevent buildup of formula.

Water should be at room temperature.

30. Clamp the tubing, remove the syringe, replace the plug, and secure the tube.

An unsecured tube can catch on something and be pulled out.

31. Wash hands. B. Post Feeding Care of Student 1. Allow student to remain in an elevated quiet position for 30 minutes to one hour after gastrostomy feeding.

Elevation helps prevent vomiting or aspiration if student regurgitates.

2. Observe student closely for untoward effects of feeding.

Watch for gagging, sweating, restlessness, color change or distended abdomen.

3. Report to nurse and/or physician if complications occur. C. Daily Care 1. Give oral hygiene as needed, as a part of classroom program.

Oral hygiene is necessary to prevent accumulation of secretions as well as dryness.

2. Clean area around button or tube daily with soap and water.

Cleaning prevents irritation and excoriation of skin. G-tube site may be left open to air. Report increased redness with yellow, green or foul smelling drainage from around the insertion site.

3. Apply sterile or clean dressing if indicated.

Dressing absorbs any discharge of gastric juices or exudate, helping to prevent skin breakdown.

D. Clean and Store Feeding Equipment 1. Flush feeding equipment thoroughly with Clean inside and out. Use brush as needed to cool tap water immediately after use to get milk products out of hard to reach places. remove milk products.

Rev 8-12 –DP – SPHCS

Page 6 of 7 Gastrostomy Tube (Syringe Feeding)

Essential Steps

Key Points and Precautions

2. Rinse with a weak solution of warm soap and water, and rinse thoroughly. 3. Soak all feeding equipment twice a week in a 1:10 vinegar solution (1 part vinegar to 10 parts tap water) for 30 minutes. 4. Rinse equipment well with tap water. 5. Shake excess water out of equipment. 6. Air dry equipment by hanging freely from stand.

Moisture breeds bacteria. This helps retard bacterial growth in tubing.

7. Place cap on syringe tip (after drying) to prevent airborne bacteria from settling on tip. 8. Between feedings, store tubing overnight in the refrigerator, if one is available. E. Record Procedure Record on Medi-Cal student log:       

Once on each new Medi-Cal log, the person doing the procedure should enter initials, Time of feeding/medication identifying signature, and titles (i.e., MJ = Type of feeding or formula Amount of feeding/formula ordered Mary Jones, RN). Classroom personnel enter initials for provider code. Amount of water flush ordered Time feeding takes to complete Procedure code for Medi-Cal log = V551; Untoward reactions (if any) Nurse = 45; HealthTech/Health Aide = 55; Initial entry and provider code Classroom personnel = 99

I have reviewed this procedure for ___________________________ Student's Name

____________ and approve Date of Birth

as indicated below: 

I approve this procedure as written.



I approve this procedure as written with the following modifications:

Physician's Name (print) Rev 8-12 –DP – SPHCS

Physician's Signature

Date Page 7 of 7 Gastrostomy Tube (Syringe Feeding)

Suggest Documents