Procedure for the Insertion of Replacement Balloon Retained Gastrostomy Device Leicestershire Home Enteral Nutrition Service

Transcription

1 Procedure for the Insertion of Replacement Balloon Retained Gastrostomy Device Leicestershire Home Enteral Nutrition Service Approved by: Clinical Governance Committee On: May 2008 Review Date: May 2010 Directorate responsible for Review Nursing and Quality Policy Number: NP074 Signature:... Anna Barrett Director of Nursing & Quality

2 Procedure for Insertion of Replacement Balloon - Retained Gastrostomy Device 1.0 INTRODUCTION The procedure gives directives for the safe and effective replacement of balloon gastrostomy devices including balloon-retained tubes and buttons. The procedure is relevant only to patients who already have a balloon-retained device or radiologically inserted gastrostomy, not to those with a Percutaneous Endoscopic Gastrostomy (PEG) 1.1 Standard Statement The replacement and subsequent management of balloon-retained gastrostomy devices will be safe, effective and comfortable for the patient. 1.2 Accountability, Authorisation and Responsibility Professionals undertaking this procedure must be:- Registered Dietitians (Health Professions Council) Full members of the British Dietetic Association Working within the Leicestershire Home Enteral Nutrition Service at Senior Specialist level. Have undertaken appropriate training in accordance with Home Enteral Nutrition Service training protocol. All practitioners are personally responsible for updating their practice to maintain competencies and skills Practitioners accept accountability for their practice 2.0 INSERTION OF GASTROSTOMY DEVICE 2.1 Equipment needed Appropriate replacement balloon gastrostomy device. (correct french gauge (FG) for tubes, correct length and FG for buttons) n-sterile, disposable gloves. Disposable Apron Appropriate waste bags Hand washing equipment i.e. soap and water, clean hand towel or paper towel, alcohol hand gel. Water soluble gel Appropriate luer tip syringe (as indicated by the manufacturers). n-iv compatible 50ml syringe Sterile or cooled boiled water. ph paper NP074 Procedure for the Insertion of Replacement Balloon Retained Gastrostomy Device Page 2 of 5

3 1. Explain the procedure to the patient/ carer appropriate to their age and development. 2. Identify means by which the patient can communicate if he/she wants the procedure to stop, e.g. by raising his/her hand. To obtain the patient/carer s consent and co-operation. The patient is often less frightened if he/she feels able to have some control over the procedure. 3. Assist the patient to lay in a comfortable position appropriate to their mobility. To facilitate efficient replacement of the tube, and to prevent undue stress. 4. Put on disposable apron. Wash hands with soap and water and put on gloves. To adhere to infection control precautions 5. Using clean technique, remove the new balloon gastrostomy tube from the packaging. 6. Inflate the new gastrostomy balloon via the balloon port with 5mls of sterile/cool boiled water to check that the balloon inflates and deflates with no leakage prior to insertion. (Deflate balloon again prior to insertion). Return the tube to the original packaging until required. 7. Using appropriate size luer tip syringe, deflate the balloon of the old gastrostomy tube via the balloon port. Ensure all the water is withdrawn 8. Apply gentle pressure and pull the old gastrostomy tube out. Put old device into appropriate waste bag. 9. Change gloves if site bleeds, exudate is present, or stoma requires cleaning 10. Lubricate end of replacement gastrostomy tube with water-soluble gel. 11. For balloon-retained tubes only - slide the external retention device to the distal end of the tube (away from the balloon). and insert the new balloon gastrostomy an appropriate length through the stoma. 12. Insert the new balloon gastrostomy an appropriate length through the stoma. To avoid contamination of new device To ensure the new gastrostomy device functions properly To enable removal of tube/button. To remove tube/button To adhere to infection control precautions To facilitate ease of insertion and minimise discomfort. To enable the tube to be inserted far enough to ensure the balloon is inflated in stomach, not the tract. To ensure the tip of the tube is in the stomach. NP074 Procedure for the Insertion of Replacement Balloon Retained Gastrostomy Device Page 3 of 5

4 13. Hold the gastrostomy tube in place and inflate the balloon via balloon port with cooled boiled or sterile water (usually 5mls but refer to manufacturers instructions), using appropriate syringe. DO NOT USE AIR 14. For tubes only - grasp the tube and withdraw until slight tension is felt from balloon against stomach wall. This is not applicable if using a button. 15. For tubes only - position the external fixation device comfortably against the abdomen. t applicable if using a button 16. Aspirate a small amount of gastric fluid using appropriate non-iv compatible 50ml syringe via feed port and place onto ph paper to check for an acidic reaction. 17. Flush the tube/button with at least 5-10 mls cooled boiled water. 18. Remove gloves and apron and dispose of into appropriate waste bag. Wash hands with soap and water. Apply alcohol hand gel. 19. Document tube replacement in dietetic notes, including product code and method used to confirm position To prevent gastrostomy device falling out. To confirm security of placement and prevent leakage of stomach contents. To prevent the tubing being drawn into the stomach. To confirm positioning of gastrostomy tube in stomach. To prevent gastric contents remaining in the device. To comply with universal precautions and Trust Waste Policy. To comply with Health Professions Council and Leicestershire Nutrition and dietetic service record keeping standards 3.0 POLICY DEVELOPMENT AND RATIFICATION Developed by the Leicestershire Home Enteral Nutrition Service. NP074 Procedure for the Insertion of Replacement Balloon Retained Gastrostomy Device Page 4 of 5

5 Equality Impact Assessment Tool To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. Yes/ Comments 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? 5. If so can the impact be avoided? 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? If you have identified a potential discriminatory impact of this procedural document, please refer it to the Policy Administrator, together with any suggestions as to the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact the Policy Administrator. NP074 Procedure for the Insertion of Replacement Balloon Retained Gastrostomy Device Page 5 of 5