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