Western General Hospital Tubefeeding Group Radiologically Inserted Gastrostomy Protocol, October 2008

Transcription

1 Lothian University Hospitals Division Western General Hospital Protocol for the Care of Radiologically Inserted Gastrostomy Tube 14 FG Medicina G Tube CARE OF PATIENT FOLLOWING TUBE INSERTION OBSERVATIONS The patient will be given sedation and analgesia - therefore monitor TPR, BP and Oxygen saturations every ½ hr for the first 2 hours then 4 hourly for 24 hours. WOUND Observe the abdominal insertion site for signs of leakage. The site may be covered with a dressing, which should be removed 24hrs post procedure. STOMA SITE Clean stoma site with saline using asceptic technique for the first 48 hours, thereafter clean with a clean cloth and water and dry thoroughly. TUBE Observe the position of the tube on return to the ward and note any outward/inward movement. If there is any outward/inward movement gently move external bumper nearer to skin, leaving at least 2mm from skin surface

2 TUBE cont. SUTURES BALLOON FLUSHING COMMENCING FEEDING MEDICINES The tube is retained by 5ml water filled balloon. The tube should be rotated 360 degrees once a day to allow for a healthy tract to form. Around the stoma there will be three sutures in situ. Please note the gastrostomy tube is not held in place by the sutures. The sutures secure the stomach wall to the abdominal wall to allow the stoma to be formed. Nursing staff should remove these sutures seven days post procedure. Raise metal fastener, cut suture and remove disc and sponge. Any remaining suture material is unlikely to cause a significant problem. An internal water filled balloon holds the tube in place. The water volume should be checked and replaced once a week, after the tube has been in situ for 2 weeks. Attach 5ml luer slip syringe to balloon port and withdraw all the fluid Discard liquid Re-inflate balloon with 5ml sterile water or as per manufacturers guidelines. Never administer anything else down this balloon port. Flush the tube with 50ml of sterile water (hospital) or cooled boiled water (community) before and after commencement of the feed and administration of medicines. Commence feeding via the gastrostomy tube as follows: Nil via the tube for the first 4 hours After 4 hours, commence feeding with formula feed at 50ml per hour or as per dietitian s regimen. Medication given via the tube should be given in liquid form where possible. Dispersible medicines may be given if dissolved well and flushed with copious amounts of sterile(hospital) or cooled boiled (community) water. Unless in exceptional circumstances crushed tablets should never be given and capsules should not be opened and administered via the tube. Please refer to the medical staff, pharmacist or nurse specialist for advice. The tube is extremely narrow (12fr) and will block easily. Never administer medicines down the balloon port. HYGIENE The patient should not have an immersion bath for 2 weeks following the procedure. Showers are permitted after 24 hours. Ensure that the stoma site is washed first. IF TUBE IS DISPLACED If a displaced tube has a track less than 2 weeks old - 2 -

3 (track less than 2 weeks Do not try and replace the tube or feed via a nasogastric tube. Monday hours, Tuesday-Friday hours contact Nutrition Nurse, Lorraine McVie or Monday-Friday, hours contact the on-call At weekends, hours contact the on-call Out of hours, hours there is no service. Cover the stoma site with a dry dressing and contact the Nutrition Nurse or GI Registrar early the following morning. In this situation, the risk of disrupting the tract with leakage of feed or gastric contents into the peritoneum or abdominal wall layers is greatest. Only an experienced member of the GI team should attempt to gently replace the tube, tape it into place and arrange a contrast study as soon as possible. If the tube will not easily pass into the tract, no effort should be made to force it, but a fine bore NG feeding tube, or small calibre Foley catheter may be gently placed through the tract, taped in place and a contrast study arranged with a view to dilating the tract to replace with a permanent tube. UNDER NO CIRCUMSTANCES SHOULD THESE TEMPORARY TUBES BE USED FOR FEEDING - THEY ARE MERELY TO MAINTAIN PATENCY OF THE TRACT ONLY following radiological confirmation that new tube is in place, commence feeding as per new tube protocol (track between 2 and 12 weeks If a displaced tube has a track between 2 and 12 weeks old Monday hours, Tuesday-Friday hours contact Nutrition Nurse, Lorraine McVie or Monday-Friday, hours contact the on-call At weekends, hours contact the on-call GI Registrar via switchboard Out of hours, hours there is no service. Cover the stoma site with a dry dressing and contact - 3 -

4 IF TUBE IS DISPLACED cont. (track between 2 and 12 weeks Nutrition Nurse or GI Registrar early the following morning. In this situation, the risk of disrupting the tract with leakage of feed or gastric contents into the peritoneum or abdominal wall layers is still relatively high. Only an experienced member of the GI team should attempt to gently replace the tube, tape it into place and arrange a contrast study as soon as possible. If the tube will not easily pass into the tract, no effort should be made to force it, but a fine bore NG feeding tube or small calibre Foley catheter may be gently placed through the tract, taped in place and a contrast study arranged with a view to dilating the tract to replace with a permanent tube. UNDER NO CIRCUMSTANCES SHOULD THESE TEMPORARY TUBES BE USED FOR FEEDING - THEY ARE MERELY TO MAINTAIN PATENCY OF THE TRACT Following tube replacement arrange an x-ray pegogram to ensure the tube is in correct position. Once tube position is confirmed feed as per established regimen. If a displaced tube has a track over 12 weeks old (track greater than 12 weeks A suitably qualified person should try and replace the tube as soon as possible. Position can be confirmed by aspirating gastric contents (aspirate ph < 5.5). If any concern about tube position, arrange x-ray pegogram to confirm tube position. Once tube position is confirmed feed as per established regimen

5 Additional information is available on intranet under policies and guidelines Tube Feeding Contact Telephone Numbers Monday ( hours) Tuesday-Friday ( hours) Contact Lorraine McVie, Nutrition Nurse (radio page ) Monday-Friday ( hours) and Weekends ( hours); Contact On-Call GI Registrar via Western General switchboard on