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 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
State, District, Board of Nursing laws, policies and guidelines
Students with Handicaps of Chronic Illnesses Autism Deaf-blindness Emotional
Disturbance Hearing Impairment Mental Retardation Multiple Disabilities Orthopedic
Impairment
Visual Impairment 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
2. Lubricate tubing
3. Gently insert into the tract• Never force tubing: this can cause a
separation of the stomach lining
4. Check placement by inserting 20-30cc of air and auscultation of stomach
• 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 Any signs of infection
Redness Swelling Warmth Discharge: yellow,
green, or foul-smelling Severe abdominal pain
Excessive bleeding or 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 g-tube
IT’S NOT OVER TILL THE PAPER WORK IS
DONE!
Practice Makes Perfect
??? Questions ???
References
David Matthau, "Protecting Jersey's Medically Fragile 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 (7-27-12)
American Academy of Chld and Adolescent Psychiatry, "Services In School For Children With Special Needs: What Parents Need to Know" (5-14-12)
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