A Percutaneous Endoscopic Gastrostomy (PEG) tube is a flexible feeding tube placed through the abdominal wall directly into the stomach. It delivers nutrition, fluids, and medications when a person cannot safely or adequately consume them by mouth.
Understanding Your PEG Tube
A PEG tube consists of several components: an external bumper or disk that rests against the skin and an internal balloon or bumper inside the stomach, which keep the tube in place. It also features a feeding port at the external end for connecting syringes or feeding sets. The tube is inserted during a procedure where an endoscope guides its placement through a small incision in the abdomen.
Daily care for the PEG tube site, known as the stoma, prevents complications and maintains hygiene. This involves gently cleaning the skin around the tube with mild soap and water, then drying the area thoroughly. Check the site for any signs of irritation or unusual drainage as part of this routine.
Preparing for Feeding
Before administering feed through a PEG tube, gather supplies. These typically include the prescribed formula, a syringe, clean water, and a feeding pump if continuous feeding is planned. Ensure the formula is at room temperature and check its expiration date.
Thorough handwashing with soap and water is essential before handling any feeding equipment or the tube itself. Position the individual receiving the feed comfortably in an upright position, or with their head elevated at least 30 to 45 degrees, to promote proper digestion and reduce the chance of complications. If using a feeding bag and tubing, prime the system by allowing a small amount of formula to flow through to remove any air before connecting it to the PEG tube.
Administering Feeds
Feeding through a PEG tube can be done using two methods: bolus feeding or continuous pump feeding. Bolus feeding involves delivering formula in larger amounts over a shorter period, often mimicking meal times.
To perform a bolus feed, remove the plunger from a large syringe and attach the syringe barrel to the PEG tube’s feeding port. Pour the prescribed formula into the syringe, then elevate it to allow gravity to flow; lowering the syringe will slow the flow. Aim for the feeding to take approximately 10 to 20 minutes. After administration, flush the tube with 30 to 60 milliliters of clean water to clear remaining formula and ensure hydration, then close the port.
Continuous feeding delivers formula slowly over an extended period using a specialized pump. This method helps individuals who do not tolerate larger volumes. To set up a continuous feed, fill the feeding bag with the prescribed formula and connect it to the pump. Program the pump as instructed by a healthcare provider, then connect the feeding bag tubing to the PEG tube’s feeding port and initiate the feed. The feeding bag should be hung above the individual, typically on an IV pole.
Regular flushing maintains tube patency during continuous feeding. The tube should be flushed with water, usually 30 to 60 milliliters, every four to eight hours and after the feed. This practice helps prevent formula buildup and clogs. Use a new feeding bag every one to two days to prevent bacterial contamination.
Managing Medications and Common Issues
Administering medications through a PEG tube requires careful handling to prevent obstruction and ensure effectiveness. Liquid medications are often preferred, but many pills can be administered after being finely crushed and mixed with water. However, certain medications, such as extended-release or enteric-coated tablets, should not be crushed. Administer each medication individually, flushing the tube with 30 to 60 milliliters of water before and after each dose to prevent clogging.
Tube clogging is a common issue that can be resolved at home. If the tube becomes blocked, try flushing it gently with warm water using a syringe, employing a gentle push-and-pull motion. Avoid forceful flushing, as this can damage the tube. Minor skin irritation around the stoma may also occur; keeping the area clean and dry with regular site care can help manage this.
When to Seek Medical Advice
Certain symptoms or situations require immediate medical attention regarding a PEG tube. These include the tube accidentally coming out or becoming dislodged, as the opening can close quickly. Signs of infection at the stoma site, such as severe pain, fever, increased redness, swelling, or pus, also require prompt attention.
Other concerns requiring medical evaluation include persistent nausea or vomiting, signs of dehydration, or if the tube remains clogged despite attempts to clear it with gentle flushing. Any significant bleeding from the insertion site or changes in abdominal pain should also be reported. These situations may indicate a serious complication requiring professional assessment.