Guidance and application of En-Plugs-S (ENP-S) 4cm in gastrostomy care, SOP

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Objectives

This policy has been developed to promote safe use of the EN-Plug-S device and to improve patient outcomes in the event where a patients balloon gastrostomy feeding device has been accidentally removed and minimise any associated risks. To ensure the correct and appropriate device is used to establish stoma patency.

Staff will adhere to the use of EN-Plugs-S as per standard operating procedure.

The Gastrostomy CNS with nurse education will ensure all staff using the EN-Plug-S device has the appropriate education and support to ensure compliance.

Scope

This policy applies to all trained nursing, medical and surgical personnel that have received training on the use of the EN-Plug-S device and have experience with the care of children with balloon gastrostomy tubes/buttons, within all areas of the hospital. The aim is to ensure the child’s stoma tract is kept patent following accidental removal, prior to the insertion of the correct gastrostomy device and reduce any associated risks with accidental removal.

Introduction

When a balloon gastrostomy button/tube is accidentally removed, there is a risk of the tract closing so it is imperative that a suitable device is inserted into the tract after displacement. EN-Plugs are specifically designed for this purpose to ensure gastrostomy tract patency whilst minimising risk. Health care practitioners and parents must have training, including awareness of the manufacturer’s instructions, before using the device to ensure that the device is used appropriately and correctly.

Our proposed standard of care for a child being discharged with a balloon gastrostomy button/tube requires that the patient has a spare device ordered in the community and that the patient is discharged from hospital with an EN-Plug-S device. This ensures the patient has the appropriate device in the event of the balloon gastrostomy button/tube being accidental removed and the device can be inserted into the patient’s gastrostomy tract in order to prevent closure. The device is only for gastrostomy use and for established tracts (>3 months since initial gastrostomy creation).

En-Plugs-S are only for short term use until the appropriate gastrostomy feeding device can be inserted into the tract by an appropriately trained person. This device is for use in the clinical setting and community setting.

EN-plugs are made of medical grade silicone and are latex and phthalate free. The product can be used from 2 years from date of manufacture. The device is for single patient use only and EN-Plugs should not to be reused. This product should not be used in any patients with a history of allergy to silicone.

En Plugs-S are only available in a packet of 4 with sizes Fr 10, 12, 14 and 16 together in packet. Each EN-Plug has the French size moulded on the top of the disc and each size has differentiating colours.

Colour and sizes - Black (10Fr), White (12 Fr), Green (14Fr), and orange (16Fr).

The EN- Plug-S length for gastrostomy use is 4 cm. There is a longer version (denoted as EN-Plug) that should not be used in children.

EN-Plugs-S should not be removed from the packaging unless it is for direct use.The packaging should be inspected before use for damage or breaches to any seal to ensure the product is not contaminated.

Standard Operating Procedure

Assessment/requirement for use of En-Plug-S

The Child’s Gastrostomy balloon device has been accidentally removed. The Gastrostomy tract must have been established for >3 months.

Establish length of time since the Gastrostomy device has been accidentally removed (see Requirements below).

If an appropriately sized gastrostomy device is available, an appropriately trained person can attempt to insert this into the tract initially (without the use of the EN-Plug-S) to prevent closure.

If the Child’s spare Gastrostomy button/tube cannot be inserted into the stoma then the appropriate EN-Plug-S should be used to prevent Gastrostomy closure.

 

Aim

To ensures stoma patency and reduce the risk of gastrostomy closure with the application of EN-Plug-S.

 

Statement

Before use, the persons using this product should have the correct education and experience, be aware of the risks associated with the insertion of this device, and awareness of the different sizes and colours associated with the EN-Plug-S.

Attention must be given to the Fr/CH size/diameter of the existing stoma. This information will be visible on the existing gastrostomy device removed or documented in operation notes.

EN- Plugs-S are only available in a packet of 4 EN-Plugs of varying sizes, therefore care must be taken not to insert an EN-Plug which is larger than the patient’s gastrostomy size (in Fr). Used correctly by the practitioner, this device can reduce the risk of complications for the patients when their balloon gastrostomy button/tube has become dislodged and improve patient outcomes.

 

Requirements

Sterile dressing pack

Before use, the stoma site should be cleaned and dried.

The stoma area should be assessed prior to insertion of the En Plug-S and the time without a device in the stoma should be noted.

Clarification of the patients gastrostomy button/tube French (Fr) and length (cm) should be sought before procedure.

Care should be taken not to use an EN-Plug-S larger than the patient’s current gastrostomy Fr size.

If the gastrostomy has been out for <4 hours try using the same size of En Plug-S i.e. equal to the patient’s current gastrostomy French size.

If the gastrostomy has been dislodged for >4 hours, try initial placement with the smaller diameter of EnPlug-S device. If this is inserted easily, attempt replacement with the correct size.

 

Procedure

Wash hands in accordance with NHS Greater Glasgow and Clyde hand hygiene policy.

Ensure packaging has not been damaged and in date.

Open dressing pack and apply gloves.

Apply water based lubricant around stoma and the distal end of device/EN-Plug.

Gently insert the distal end of the EN- Plug-S into the existing gastrostomy tract. The EN-Plug has a tapered tip to aid insertion.

Excessive force should not be used to insert device.

If there is resistance experienced on insertion of device (or if the gastrostomy has been out for >4 hours) try the next smaller EN-Plug-S to aid gentle insertion into tract, as the stoma may have already started to close. If this goes in easily, the correct size can be tried again.

If unable to insert the smallest EN-Plug-S or insertion is problematic then medical/surgical advice should be sought immediately.

Once the EN-Plug-S is inserted, the product should be taped to the patient’s abdomen and contact should be made with the appropriate health care professionals to arrange replacement as soon as possible.

 

Audit requirements

Audit specific area e.g. ED department/patients where use of this product would be higher than other areas within the hospital.

References

GBUK Enteral website: http://www.gbukenteral.com 

NHSGGC Infection Control procedures: http://www.nhsggc.org.uk/infectioncontrol

Editorial Information

Last reviewed: 01 November 2019

Next review: 01 November 2021

Author(s): Sister Louise Paterson, Clinical Nurse Specialist- Gastrostomy & Mr. Gregor Walker, Paediatric Surgical Consultant

Co-Author(s): Contribution: Sister Lynsey Ure, Nurse Education

Approved By: Clinical Effectiveness

Reviewer Name(s): Paediatric Educator Group