Transcript Gastrostomy Tube Reinsertion

Gastrostomy Tube
Reinsertion
Ramona Garcia
Medically Fragile
New Jersey defines the medically fragile
as one who suffers from a life
threatening medical condition… and
need individualized and continuous care
typically provided by a school nurse …
Our students
Background
 1970: student needs were meet by
hospitals and other institutions
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Educational Development
Medical Requirements
Background
 1975: The Education for LL Handicapped
Children Act (EAHCA) public law 94-142
 Disabilities Education Act (IDEA)
This changed the scope of education for the
medically fragile
Background
EAHCA and IDEA identified the need to
provide services to a large population of
school age individuals who were not
serviced or were under serviced
Entitles all students to an education
especially those who require complex
health procedures
School Nursing Today
 More Students
 More Regulations on care
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State, District, Board of Nursing laws, policies
and guidelines
Students with Handicaps of Chronic
Illnesses
 Autism
 Visual Impairment
 Deaf-blindness
 Emotional
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Disturbance
Hearing Impairment
Mental Retardation
Multiple Disabilities
Orthopedic
Impairment
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including blindness.
Specific Learning
Disability
Speech or Language
Impairment
Traumatic Brain
Injury
Other Health
Impairment
How will we meet the needs for the
student with a gastrostomy tube ?
Nursing Practice Law 15.24
Provides specific guidelines, rules, and
considerations that must be applied in
order for the reinsertion of the gastrostomy
tube
Eight Steps to Success
Nursing Practice Law 15.24
1.
The length of time the student has had the
tube in (8-12 weeks at least) for
maturation/healing of the fistulous track and
stoma formation
2.
Orders must be obtained by a physician
Nursing Practice Law 15.24
3.
The nurse should complete training designed
specifically for the type of permanent feeding tube,
including overall patient assessment, verification of
the proper tube placement, and assessment of the
tube insertion site
4.
The nurse demonstrates competency in all
appropriate aspects (knowledge, decision making,
and psycho-motor skills of performing the procedure
Nursing Practice Law 15.24
5.
The patient has an established tract as
determined by a physician
6.
The facility has resources available to
develop an education program for initial
instruction of RNs and LVNs as well as
ongoing competency validation
Nursing Practice Law 15.24
7.
Documentation of each nurse’s initial
education and ongoing competency
8.
Regardless of training, policies, and
procedures, the facility must also permit the
nurse to engage in the procedure
MIC-Key Button Gastrostomy Tube
• balloon inflation valve
• anti-reflux valve
• The end of the balloon
has a tapered tip and a
inflatable balloon that
is filled with water after
the catheter is in place
and keeps the catheter
in place
What if the tube
becomes dislodges?
Remember the feeding tube tract can narrow
and close within hours of the tube removable
Equipment Needed to Replace a
Feeding Tube
 Gloves
 Stethoscope
 Gastrostomy tube
 Lubricant
 Syringe that fits tube for air
insufflations
 Syringe the fits tube for
saline inflation
 Saline
Replacing a Feeding Tube
1. Assess site and balloon
• Is there a leak?
o Yes reinsert tube and notify physician
• Are there signs of infection?
o Yes  reinsertion is contraindicated
Replacing a Feeding Tube
Lubricate tubing
3. Gently insert into the tract
2.
•
Never force tubing: this can cause a
separation of the stomach lining
Check placement by inserting 20-30cc of
air and auscultation of stomach
4.
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You may also see gastric contents in the
tubing.
Replacing a Feeding Tube
5.
Insert 100cc on saline using a 100cc
syringe into the anti-reflux valve
6.
Proper documentation of the
procedure
7.
Notify parent or guardian before the
next feed
Complications to monitor and address
 Blocked or clogged tube
 Excessive bleeding or
 Any signs of infection
drainage from the tube
site
 Persistent vomiting or
diarrhea
 Trouble passing gas or
having a bowel movement
 Pink-red tissue (called
granulation tissue) coming
out from around the gtube
Redness
 Swelling
 Warmth
 Discharge: yellow,
green, or foul-smelling
 Severe abdominal pain
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IT’S NOT OVER TILL
THE PAPER WORK IS
DONE!
Practice Makes Perfect
??? Questions ???
References
 David Matthau, "Protecting Jersey's Medically Fragile
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Kids At School."
Ruby Ferguson MSN, RN, "Gastrostomy Tube
Feeding int the School Setting."
Texas State Board of Nursing Rules and Policies:
Regulation number 15:24
Dr. Edrik D. Schragg and DrRick Kulkarii, Chief editor
Medscape, "Gastrostomy Tube Replacement (7-2712)
American Academy of Chld and Adolescent
Psychiatry, "Services In School For Children With
Special Needs: What Parents Need to Know" (5-1412)