PROCEDURE FOR CHECKING THE WATER IN BALLOON RETAINED GASTROSTOMY TUBE / LOW PROFILE DEVICES FOR BOTH ADULTS AND CHILDREN

Transcription

1 PROCEDURE FOR CHECKING THE WATER IN BALLOON RETAINED GASTROSTOMY TUBE / LOW PROFILE DEVICES FOR BOTH ADULTS AND CHILDREN First Issued Issue Version Purpose of Issue/Description of Change Planned Review Date One To ensure sufficient water is in gastrostomy feeding tubes / low profile devices to prevent them from falling out and prevent admissions into hospital 2016 Named Responsible Officer:- Approved by Date Community Nutrition and Dietetic Service Quality, Patient Experience and Risk Group September 2013 CP31 Target Audience Community Nursing Service and Community Nutrition and Dietetic Service UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE TRUST WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

2 CONTROL RECORD Title Procedure for checking the water in balloon retained gastrostomy tubes / low profile devices for adults and children Purpose To ensure sufficient water is in gastrostomy feeding tubes / low profile devices to prevent them from falling out and prevent admissions into Author hospital Quality and Governance Service (QGS) / Community Nutrition and Dietetic Service Equality Assessment Integrated into procedure Yes No Subject Experts Maria Lee, Fiona Sinnott, Alice Sutton Document Librarian Groups consulted with :- QGS Clinical Policies and Procedures Group, Infection Control Approved Date formally approved by Quality, Patient Experience & Risk Group 25 th September 2013 Method of distribution Intranet Archived Date Location S Drive QGS Access VERSION CONTROL RECORD Version Number Author Status Changes / Comments Version 1 ML N Status New / Revised / Trust Change 3

3 PROCEDURE FOR THE CHECKING THE WATER IN BALLOON RETAINED GASTROSTOMY TUBE / LOW PROFILE DEVICES FOR ADULTS AND CHILDREN INTRODUCTION It is important to check the water in balloon retained gastrostomy tubes and low profile devices to ensure there is sufficient water in the balloon to keep it in the correct place. Water in the balloon can migrate over time through the balloon membrane and lose volume. Balloons can rupture and develop leaks due to several factors including gastric ph, tube care, over-inflation of the balloon and various medications therefore checking the balloon regularly can reduce the risk of the tube / device accidentally falling out, thus minimise / prevent attendance into Accident and Emergency Department. Most manufacturers of gastrostomy tubes and low profile devices recommend that balloon checks be done weekly. When doing the procedure avoid checking the balloon at the time of day when access to help can be limited. TARGET GROUP All registered health professionals who are required to carry out this procedure as part of their role. TRAINING All staff in the Trust are required to comply with mandatory training as specified in the Trusts Mandatory Training Matrix. Clinical Staff are also required to comply with service specific mandatory training as specified within their service training matrix. Training for community nurses / health professionals can be provided by the Community Dietetic Team if required. RELATED POLICIES Please refer to relevant Trust policies and procedures CONSENT Valid consent must be given voluntarily by an appropriately informed person prior to any procedure or intervention. No one can give consent on behalf of another adult who is deemed to lack capacity regardless of whether the impairment is temporary or permanent. However such patients can be treated if it is deemed to be within their best interest. This must be recorded within the patient s health records with a clear rationale stated at all times. Refer to Trust Patient Information and Consent Policy for further information and guidance or the Clinical Protocol for Assessing Mental Capacity and Best Interests. COMMUNITY NUTRITION AND DIETETIC SERVICE All patients with a feeding tube insitu should be known to the Community Nutrition and Dietetic Service. If a health professional encounters a patient in the community with concerns regarding any aspect of their feeding tube or stoma site, please inform the department. 4

4 CHECKING THE BALLOON EQUIPMENT 2 X single use Luer slip syringes, size depends on balloon size, usually 5-10ml is adequate Sterile water x 10 ml ampoule Pouds Tray or single use sterile dressing pack Single use non sterile disposable gloves (if using POUD tray) Single use disposable apron (if using POUD tray) PROCEDURE Staff members to introduce themselves Explain and discuss the procedure with the patient and relevant family members / carers. Verbally check the identity of the patient by asking the patient s full name and date of birth. Check with carer / family if patient not able to confirm identity Wear identity badge which includes name, status and designation Explain procedure and obtain informed and valid consent, if patient unable to consent, record procedure as best interest in health care records Ensure verbal consent for the presence of any other third party is obtained Explain the procedure to patient including risks and benefits and gain valid consent Decontaminate hands prior to procedure Clean tray using Trust approved cleaning wipe of if indicated open sterile dressing pack onto a clean area and place all sterile single use equipment within aseptic field maintaining key part protection at all times. Apply single use disposable apron Apply single use disposable non sterile gloves Using Aseptic Non Touch Technique (ANTT) pre fill one syringe with the volume of water required as stated on the balloon inflation valve or the volume advised by Dietetic Service For balloon retained gastrostomy tubes Move the external fixator away from the body by approximately 2 4cm and gently push the tube into the stomach For low profile devices Hold the device in place RATIONALE To ensure understanding of the procedure To promote mutual respect and put client at their ease. To check correct identity of patient For patients to know who they are seeing and to promote mutual respect To allow the patient / client to make an informed decision and gain co-operation Discuss any preferences with main carer if needed to ensure the correct documentation is completed Students for example, as the patient has the choice to refuse To ensure client understands procedure and relevant risks To reduce the risk of transfer of transient microorganisms on the healthcare workers hands To prevent contamination of key parts. To protect clothing or uniform from contamination and potential transfer of micro-organisms To protect hands from contamination with organic matter and transfer of micro organisms To ensure the correct volume of water is inserted into the balloon To ensure the tube does not fall out during the procedure 5

5 Using an Aseptic Non Touch Technique (ANTT), attach the empty syringe to the balloon inflation valve securely and gently pull back on the syringe plunger until no more water comes out of the balloon. Discard the water. Repeat several times If you can not withdraw any water from the balloon contact the patient s dietitian for guidance Note: record in healthcare notes or keep a record of how much water is removed from the balloon each week, it is common to lose water from the balloon Hold the gastrostomy tube / low profile device in place. Using an Aseptic Non Touch Technique (ANTT), attach the pre-filled syringe to the balloon inflation valve and inflate the balloon with the correct volume of sterile water. For balloon retained gastrostomy tubes Gently pull the tube until resistance is felt and then move the external fixator so that it is snug against the stomach On completion of the procedure remove and dispose of Personal Protective Equipment (PPE) Decontaminate hands following removal of PPE Document all actions and observations in health care records To prevent contamination of key parts and key site To deflate the balloon - ensure all the remaining water from the balloon has been removed This could indicate a damaged valve, which may require a tube change or excess water loss from the balloon To monitor the rate of water loss from the balloon To prevent contamination of key parts and key site To inflate the balloon and provide anchorage in the stomach To form good seal around the stoma site and prevent excess movement of tube in tract To prevent cross infection and environmental contamination To remove any accumulation of transient and resident skin flora that may have built up under gloves and possible contamination following removal of PPE Ensure compliance with Trust record keeping guidelines INCIDENT REPORTING Clinical incidents or near misses must be reported and a Trust Incident Form must be completed. EQUALITY ASSESSMENT During the development of this procedure the Trust has considered the clinical needs of each protected characteristic (age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief, sexual orientation). There is no evidence of exclusion of these named groups. If staff become aware of any clinical exclusions that impact on the delivery of care a Trust Incident form would need to be completed and an appropriate action plan put in place. REFERENCES Crest (Clinical Resource Efficiency Support Team) Guidelines for the management of enteral tube feeding in adults National Institute for Health and Clinical Excellence (2006) Nutrition support in adults: Oral nutrition support, enteral tube feeding and parental nutrition Vygon Enteral feeding: care and maintenance of the stoma site and feeding tube 6