Authors: Brikez Yu., Rednenko V.V., Rednenko L.I.

Editor: Rednenko V.V.

Equipment for the practical skill:

  • gastrostomy tube feeding simulator
  • gastrostomy tube (G tube)

  • manipulation table
  • sterile Janet's syringe
  • container (cup) with pureed or liquid food, volume of 200 ml
  • container (cup) with warm boiled water with a volume of 100 ml
  • warming container with hot water 
  • sterile gauze pads - 1 package
  • skin antiseptic
  • medical spatula
  • protective paste for the skin
  • clamp (in case a clamp on the gastrostomy tube is absence)
  • scissors
  • adhesive plaster
  • absorbent sheet (napkin)
  • PPE: mask, non-sterile gloves, apron
  • surgical forceps in the package 
  • working solution of a chemical disinfectant in containers:
    • "Rinsing of MI"
    • "Disinfection of MI"
    • "Disinfection of dressings, PPE"
  • medical waste container
    • "Plastic" 
      "Packaging" 
  • waterproof bag for linen

Clinical situation:

  • You are a nurse in the surgical department. A 76-year-old patient has been admitted to your ward of oncological hospital. She has an inoperable tumor of the esophagus, which completely obstructs the lumen. Two days ago, the patient underwent gastrostomy with the insertion of a special tube for artificial feeding. The patient is prescribed feeding 5 times per day, in a volume of 200 ml.
  • Feed the patient through the gastrostomy tube, take care of the gastrostomy tube, and teach the patient to self-care and feeding after stoma formation after 7-10 days

Order of the skill performance:

Preparatory stage:

  • Greet the patient, introduce yourself, identify the patient (specify the last name, first name and patronymic of the patient)
  • Inform the patient about the procedure, get verbal consent to giving it
  • Prepare your workplace
    • Check the integrity of the packages of sterile medical items, dressings, protective paste  and expiration dates
    • Arrange items for the procedure on a manipulative table
    • Place container with food and water into warming container
  • Prepare the patient for the procedure
    • Ask the patient remove clothing from the gastrostomy tube location.
    • Assist the patient to get into a comfortable position: the upper half of the body should be at an angle of 30-45 degrees
  • Put on your protective equipment
    • Put on your apron, mask
    • Perform hygienic hand antisepsis
    • Put on non-sterile gloves
  • Prepare the MI for the procedure
    • Open the package with gauze pads
    • Open the package with gauze balls
    • Open the package with Janet's syringe
    • Open the package with a spatula
    • Open the package with tweezers
    • Check the temperature of the water in the warming contaner (t - 38-40 ° C): put the thermometer into the container, remove the thermometer and place it on the table
    • Cut 3-4 strips of adhesive tape of 10 cm with scissors

Maine stage:

Before feeding:

  • prepare the gastrostomy tube for feeding
    • remove gently 
    • remove the dressing with tweezers from the stoma
    • place the used dressing and tweezers in the waste tray
    • take the napkin and cover the belly below the gastrostomy
    • examine the G tube and surrounding skin
  • check for residual gastric contents:
    • remove the plug from the tube outlet
    • connect Janet's syringe with the G tube
    • open (remove) the clamp of the G tube
    • slowly pull the plunger of the syringe towards you, if the amount of residual content is
      • less than 100 ml, return it back and rinse the G tube
      • more than 100 ml, return it back and ask a doctor to determine the feeding volume
  • rinse the gastrostomy tube
    • close the tube clamp
    • disconnect the syringe from the G tube
    • withdraw 30 ml of warm boiled water into the syringe
    • connect the syringe to the G tube
    • open the clamp
    • inject 30 ml of warm boiled water into the G tube
    • close the clamp
    • disconnect Janet's syringe from the G tube
    • close the tube clamp
    • disconnect the syringe
  • feed the patient
    • remove the plunger from the syringe barrel and place the plunger back into the package
    • connect the Janet's syringe barrel to the tube connector and, holding the syringe barrel at an angle, pour liquid food mass into it
    • open the tube clamp
    • feed by "gravity" (for 10-15 minutes): adjust the feed rate by raising and lowering the barrel of the syringe with food (if it is difficult for food to pass through the G tube, use the syringe planger)
    • close the clamp and disconnect the syringe when the feed is completed
  • rinse the gastrostomy tube
    • withdraw 50-100 ml of boiled water into a syringe
    • connect Janet's syringe to the gastrostomy tube
    • open the clamp and inject water with Janet's syringe
    • close the clamp, disconnect Janet's syringe
    • close the tube outlet with a plug
    • remove the napkin
  • take care of the gastrostoma
    • treat gloves with an antiseptic
    • lift the disk (outer catch)
    • treat the skin around the gastrostomy
    • take a sterile gauze ball with new tweezers
  • wet it with an antiseptic and gently, without pressure, treat the skin around the gastrostomy
  • place the gauze ball in the waste tray
  • treat the gastrostomy tube
    • take the second ball with the same tweezers, wet it with an antiseptic and gently, without pressure, treat the gastrostomy tube under the disk and the disk
    • slide the disk over the treated section of the tube
    • treat the rest of the G tube
    • place the gauze ball in the waste tray
  • apply a protective paste on the skin
    • take a dry gauze napkin with the same tweezers and dry the skin around the stoma without pressure
    • place a ball and tweezers in the waste tray
    • take a disposable spatula and apply a protective paste (ointment or gel) on the skin around the gastrostomy with a thin layer
    • place the spatula in the waste tray
    • leave the protective paste for 1-2 minutes to dry
  • bandage
    • take the gauze pad and make a T-shaped incision on it
    • apply a sterile gauze pad around the gastrostomy tube on the skin
    • fix this pad to the skin with strips of adhesive plaster
  • check (adjust) the position of the gastrostomy tube in the stoma
    • gently pull the G tub towards you until it stops (by the balloon into the stomac)
    • adjast the disk to 2-5 mm from the skin surface
    • gently fix the end of the G tube with a plaster to the skin of the abdominal wall (in a place convenient for the patient)
  • teach the patient to care for the stoma at home (after it has been formed in 7-10 days), recommending
    • the total volume of tube feeding is 1800 ml per day, 300 ml per meal at a rate of no more than 30 ml per minute
    • wipe the skin with warm boiled water and soap, dry it and, if necessary, treat it with an alcohol-free antiseptic at least once a day
    • keep the skin around the gastrostomy tube dry
    • rotate the gastrostomy tube 360 ​​degrees every day to avoid the build-up of granulation tissue around the stoma
    • move up and down the clamp along the G tube every other day for the protection of a G tube deformation

Final stage:

  • place the used dressing  in the container "Disinfection of dressing material, PPE"
  • rinse Janet's syringe in the "Rinsing of MI" container
  • place Janet's syringe disassembled, tweezers, a hemostatic clamp (if it used), a spatula, a tray into the container "Disinfection of medical items"
  • place containers with pure food  and  boiled water (after using) inside ”Plastic “ container
  • place the protective sheet  inside waterproof bag for linen 
  • Place the packages from MI in the ”Packaging“ container
  • remove the mask and place it in the  "Disinfection of dressings, PPE" container
  • take off the  apron and disinfect it using spray metod
  • take off gloves, place it in the "Disinfection of dressings, PPE" container
  • perform hygienic hand washing
  • record the procedure in the medical records

 

Последнее изменение: четверг, 26 ноября 2020, 15:38