A Percutaneous Endoscopic Gastrostomy (PEG) tube is a feeding device placed through the abdominal wall directly into the stomach. It provides a safe, long-term method for delivering nourishment, hydration, and medication when a person cannot swallow or eat enough by mouth. A plastic disk inside the stomach and an external fixation plate on the skin hold the tube in place. Accurate administration requires precise preparation and consistent technique to maintain the tube’s function and prevent complications like clogs.
Preparing Medications for Tube Delivery
Liquid medication formulations are preferred for administration through a PEG tube because they reduce the risk of clogging. If a liquid is unavailable, immediate-release tablets can be prepared, but a healthcare provider must first confirm the medication is safe for crushing. Certain oral formulations must never be crushed or opened, as this can destroy their therapeutic effect or cause toxicity.
Tablets that are enteric-coated, sustained-release (SR), extended-release (XR, XL), or controlled-release (CR, CD) are unsuitable for tube delivery. These specialized coatings ensure the drug is released slowly or protect it from stomach acid, and crushing them defeats this purpose. If a drug is only available in one of these prohibited forms, the prescribing professional should be consulted to find an alternative drug or formulation.
To prepare a tablet, it must be crushed into a very fine powder using a pill crusher or mortar and pestle. The powder is then fully dissolved in a small amount of warm water, typically 15 to 30 milliliters, ensuring all particles are suspended. Each medication must be prepared separately in its own container. Mixing different medications is discouraged due to the risk of chemical interactions, tube obstruction, or altered drug absorption.
Administering Medication: The Step-by-Step Process
The administration process begins with meticulous hand hygiene. After gathering all necessary supplies, the person should be positioned with their head elevated at least 30 degrees. This upright position helps reduce the risk of reflux and aspiration during the procedure.
Before any medication is introduced, the tube must be flushed with water to ensure it is clear and patent. For adults, a flush volume of 15 to 30 milliliters is recommended. This initial flush clears any residual formula or stomach contents, preparing the tube for medication. If the tube is connected to a continuous feeding pump, the feeding must be paused before the flush.
The prepared medication solution is administered one dose at a time, using a syringe attached to the tube’s port. The medication should be delivered slowly, either by allowing gravity to draw the liquid down or by using a gentle push on the syringe plunger. Rapid administration can cause discomfort, cramping, or spasms in the stomach.
After each individual medication dose, the tube must be flushed again with water, typically 15 milliliters. This flush ensures the entire dose reaches the stomach and prevents interactions between different medications that could lead to clogging. Once all medications have been given, a final water flush of 30 to 60 milliliters is performed to completely clear the tube and maintain its patency.
Troubleshooting Clogs and Maintaining Tube Integrity
Preventing tube clogs is achieved through consistent and adequate flushing before, between, and after every use. Proper preparation of solid medications, including crushing them into a fine powder and ensuring they are fully dissolved, is also effective. Avoid using overly viscous liquids or mixing medications with feeding formula, as both increase the likelihood of blockages.
If a partial clog is suspected due to increasing resistance during flushing, the first intervention is to attempt to clear it with a warm water flush. Using a 30 to 60 milliliter syringe, gentle pressure should be applied, sometimes using a “push-pause” technique where the plunger is rocked slightly. Never use excessive force, as this risks rupturing the tube.
If the warm water flush fails, commercially available declogging products, which often contain specific enzymes, may be used as directed by a healthcare professional. Substances like carbonated drinks or unapproved household items should be avoided, as they can worsen the clog or damage the tube material. For long-term maintenance, the skin around the tube site should be inspected daily for signs of irritation, redness, or discharge.
Contact a healthcare provider immediately if a clog cannot be cleared with gentle methods, if the tube appears discolored, or if there is any sign of displacement, such as a change in external tube length. Persistent pain, bleeding, or significant leakage around the insertion site also warrant professional attention, as these may indicate a complication requiring tube replacement. Regularly cleaning the external tube fittings and ensuring the external fixation plate is correctly positioned, typically about 5 millimeters from the skin, prevents undue pressure.