Policy Manual sample

MDT Home Health Care Agency, Inc. 55 GASTROSTOMY TUBE CARE PURPOSE: RNs who have successfully completed the required credentialing may reinsert gastrostomy tubes into mature stoma sites. A physician's order is required for the change and should include type, size of tube, and size of balloon to be used. RESPONSIBLE PERSONNEL : RN with documented credentialing SUPPLIES AND EQUIPMENT: • Replacement G tube • Sterile water • Water-soluble lubricant • Disposable gloves • Syringe • Water • 4 x 4s • Supplies for cleaning stoma site • Tape • Skin prep PROCEDURE: 1. Wash hands. Explain procedure to patient. 2. Place patient in supine position with head slightly elevated. 3. Put on disposable gloves. Inspect site for redness, drainage or other signs and symptoms of infection. Wash stoma site with warm soapy water; rinse. 4. Withdraw air or sterile water from balloon. 5. Gently rotate tube between fingers . 6. Pull directly out from abdominal cavity. Use firm , constant pressure. Avoid dripping of gastric secretions on the skin in the area of the stoma. Cleanse immediately if this occurs. 7. Place the removed tube in plastic bag along with any soiled dressing material. Close bag and dispose of according to policy. 8. Put on clean gloves. 9. Lubricate tip of gastrostomy tube with water-soluble product. 10. Insert gastrostomy tube into stoma. 11. Do not force. 12. Call physician if you are not able to insert without force. 13. Instill 5-8 ml of sterile water/air in balloon. Amount may vary depending on size of balloon. Follow manufacturer's guidelines. 14. Aspirate stomach contents by applying gentle suction with syringe. 15. Clean around stoma with warm soapy water. Rinse and dry thoroughly. 16. Assess for signs of excoriation secondary to friction with tube or exposure of skin to gastric acids. Skin barrier preparations are sometimes indicated. 17. Secure tube to abdomen with hypo-allergenic tape. 18. Apply dressing as ordered by physician. DOCUMENTATION: Document the type and size of tube inserted, verification of tube placement, condition of the stoma site and condition of the surrounding skin on the Clinical Visit Note. Document follow up with physician as indicated. ____________________________________________________