Gastrostomy Tube Reinsertion Ramona Garcia

Medically Fragile Our students 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

This changed the scope of education for the medically fragile 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 Eight Steps to Success 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 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 Orders must be obtained by a physician

Nursing Practice Law 15.24 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 The nurse demonstrates competency in all appropriate aspects (knowledge, decision making, and psycho-motor skills of performing the procedure

Nursing Practice Law 15.24 The patient has an established tract as determined by a physician 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 Documentation of each nurse’s initial education and ongoing competency 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 Assess site and balloon Is there a leak? Yes reinsert tube and notify physician Are there signs of infection? Yes  reinsertion is contraindicated

Replacing a Feeding Tube Lubricate tubing Gently insert into the tract Never force tubing: this can cause a separation of the stomach lining 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 Insert 100cc on saline using a 100cc syringe into the anti-reflux valve Proper documentation of the procedure 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)