Question: Has anyone heard of any regulations related to G-tubes that have come out recently? A friend of mine is saying that her building is being cited for not following the new guidelines related to checking g-tube placement, but I don't know of any.
Answer: I believe this is what you're looking for – see the NOTE verbiage. It's found on page 337 in Appendix PP of the State Operations Manual.
How to verify that the tube is functioning before beginning a feeding and before administering medications, which may include:
• Checking gastric residual volume (GRV)
o Not recommended for individuals who are alert and able to report symptoms that indicate a feeding is not well tolerated.
o May be appropriate when initiating tube feedings or for individuals who are unable to report symptoms such as bloating, nausea, or abdominal pain.
o Actions to take based upon the amount of GRV vary depending on the individual and the clinical condition.
o pH of GRV may indicate correct placement i.e. pH < 5 generally indicates gastric contents versus intestinal contents but medications and feeding formulas can alter pH levels.
o Changes in GRV appearance may also be helpful in confirming placement but should not be used in isolation.
• Observing changes in external length of tubing may indicate a change in position but can only be used if the exit site was marked upon initial placement; this method does not apply to low profile G tubes (tube that sits at skin level).
NOTE: Auscultation is no longer recommended for checking placement of the feeding tube. Movement of air would likely be heard whether the tube was in the correct or incorrect location. X-ray confirmation is the most accurate method for verification of tube placement when concerns arise regarding dislodgement or placement. Additional information regarding monitoring of feeding tubes may be found at, https://www.ismp.org/tools/articles/ASPEN.pdf
Mary Madison, RN, RAC-CT, CDP
Clinical Consultant, LTC/Senior Care
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