Peg

Percutaneous endoscopic gastrotomy - Care and precautions

1. PEG TUBE CARE
BY
Manju Mulamoottil Abraham

2. Percutaneous Endoscopic Gastrostomy
•A Gastrostomy Tube (G-tube) is either a tube or button (skin-
level device) placed into the stomach through the abdominal
(belly) wall. PEG feeding tubes are increasingly used for long
term Enteral nutrition.

3. Methods of PEG feeding
•Tube feeding can be given in 3 different ways – using a pump,
using gravity drip or using a syringe.
•A pump is used for continuous or intermittent feeds where the
formula is given without stopping over 8-24 hours.
•A gravity drip is used to give larger amounts of formula over a
shorter period of time usually 4 to 6 times each day.
• Feeding using a syringe is the fastest method where larger
amounts of formula are given at a time. Feeding using a syringe
or gravity drip can also be called bolus feeding.

4. Bolus Feed procedure
Step 1 Assemble all equipment
•Prescribed Formula
•Feed container and giving set
•Drinking water
•Feeding Syringe
•Measuring cup

5. Step 2 Wash hands well with soap and water
Step 3 Apply clean gloves
Give feed (see tube feeding plan as prescribed by treating
Doctor )
• Fill syringe with the set amount of warm water and gently push
it through the feeding tube (this is a flush)
• Measure the set amount of formula into a measuring cup (or
you can use the measuring scale on the syringe instead) .
•Remove plunger from syringe
•Rinse syringe with water and attach to feeding tube
•Tu

6. •Pour formula into syringe
•Hold the syringe higher than where the feeding tube goes in .
Let the formula run in slowly by gravity. If you have a thin tube
you may need touse the syringe plunger to gently push the
formula through your tube.
•Try not to let the syringe get empty before refilling it, as air
will enter the stomach
• Take at least 15 minutes to give a feed

7. When finished
•Flush the tube with the prescribed amount of
water
•Disconnect syringe and recap feeding tube
•Clean and replace the articles
•Wash hands
•Document the procedure in nurses note/
record.

8. Care of the site
•Assess the site daily for signs and symptoms of infection
redness, swelling, pain, drainage, strong odor.
•Small amounts of serosanguinous drainage and redness is
normal.
•Site should be cleaned twice daily with saline for the first
week and then soap and water
•Tube should be rotated with each cleaning
•Split non-adherent dressing should be changed with
cleanings

9. •Protect the tube and site
•Prevent excessive movement of the tube
•Prevent the tube from being pulled out or
becoming tangled
Care of the tube

10. To prevent a blocked tube
• Always crush medications well before giving through the
feeding tube.
•Always flush the feeding tube with 40mL water before,
between and after giving medications.
• Always flush the tube with at least 40mL water every 4 hours
or 8 hours if overnight.
• Always begin and finish each feeding session with a water flush.
This keeps the tube clean and stops feed building up inside the
tube.

11. Other nursing considerations
• Mouth care is extremely important in patients not taking in
oral nutrition.
•Brush teeth twice daily as you normally would
•Keep mouth moist with swabs
•Can use mouthwash to swish and spit
• Use lip balm to avoid chapped lips

12. •Manju M Abraham