Policy Manual sample

MDT Home Health Care Agency, Inc. 39 PROCEDURE: 1. Wash hands. Assemble equipment and supplies. 2. Explain procedure to patient, and position as if for feeding. Put on gloves. 3. Examine tube for external signs of displacement: • Disturbed stabilization • Abnormal length of tube (shorter or longer than previously observed) 4. Disconnect and unclamp tube. 5. Gently milk tube from point end of insertion to distal end, and allow passive gravity drainage. 6. Fill a syringe with 20-30 ml warm water. Instill and withdraw water with gentle plunging action. 7. After a few minutes, wait for water to dissolve plug, then withdraw water from tube. 8. Gently milk tube again from proximal to distal end as in step 5. 9. Instill acidic, strained juice or fresh, cold carbonated beverage into tube, and clamp for 10 to 15 minutes. Cranberry and citrus juices approximate acidity of gastric secretions. Carbonated beverages may be acidic or basic. Carbonation is most concentrated from a chilled, freshly opened container. Carbonation may work by loosening particles from a mass or by creating pressure in tube. Acidic solutions may be more effective with plugs of medication. With feedings, acidic solutions coagulate protein and form a more solid plug. 10. Monitor patient for signs of discomfort or distress. Observe abdominal insertion site for signs of leakage. 11 . Withdraw juice or carbonated beverage with gentle plunging. 12 . As final approach, mix I tablespoon meat tenderizer with I ounce water. Draw up in syringe, instill into tube and clamp tube for 30 minutes. 13. Gently aspirate tenderizer solution from tube. Vigorous plunging may further solidify plug or rupture tube. Use warm water for gentle plunging as in step 6. 14. Discard tenderizer aspirant and any material unclogged from tube. 15. Flush tube thoroughly with water and resume feeding as appropriate. 16. If attempts to unclog tube are unsuccessful, report to physician for further intervention. DOCUMENTATION: Document the problem, the approaches used and the outcome on the Clinical Visit Note. Document physician notifications and orders received as indicated. ____________________________________________________