Certified Pediatric Nurse (CPN)

Marcia has a gastrostomy tube (GT) placed due to TEF. What is a critical nursing instruction for her discharge?

1. Clean the GT site with alcohol daily

2. Flush the GT with 2 ounces of saline before each feed

3. Check for residual formula before the next feeding

4. Replace the GT immediately if it falls out

The correct answer is: Check for residual formula before the next feeding

Checking for residual formula before the next feeding is a critical nursing instruction for Marcia's discharge after her gastrostomy tube placement due to tracheoesophageal fistula (TEF). This practice is essential for several reasons. First, checking residuals helps assess gastric emptying and ensures that Marcia's stomach can handle the upcoming feed without becoming overloaded. If there is a significant amount of residual formula, it may indicate delayed gastric emptying, and feeding might need to be held or modified to prevent complications such as aspiration or discomfort. Additionally, monitoring for residuals can assist in tailoring her feeding schedule and volume to her individual needs, which is particularly important for pediatric patients who may have varying levels of tolerance in response to their specific medical conditions. While maintaining the gastrostomy tube site is essential, using alcohol, as mentioned in one of the other options, can be too harsh and may irritate the skin, making it less suitable for routine cleaning. Flushing the tube with saline before each feed is a good practice, but it should align with specific physician or facility protocols rather than being a universal rule. Replacing the tube immediately if it falls out is critical, but this situation should be addressed according to specific guidelines provided for emergencies to