A Percutaneous Endoscopic Gastrostomy (PEG) tube is a soft, flexible device inserted through the abdominal wall directly into the stomach. This procedure provides a reliable route for delivering nutrition, necessary hydration, and prescribed medications when a person cannot safely take adequate amounts by mouth. The PEG tube allows for enteral feeding, meaning the digestive process continues naturally while bypassing the upper gastrointestinal tract.
Preparing for Feeding and Checks
Before starting any feed, perform thorough hand hygiene with soap and water. Collect the prescribed formula, a syringe or pump setup, and the correct amount of water for flushing. The formula should be at room temperature, as cold formula can cause stomach cramping.
Correct positioning prevents complications like aspiration. The individual must be sitting upright or have the head of the bed elevated to at least a 30 to 45-degree angle. This position must be maintained throughout the feeding and for at least 30 to 60 minutes afterward to allow stomach contents to settle.
Check the gastric residual volume (GRV) before a bolus or intermittent feed, as instructed by a healthcare provider. This involves gently withdrawing stomach contents using a syringe to measure the remaining fluid. High residual volume (over 100 to 200 milliliters) suggests delayed stomach emptying, increasing the possibility of regurgitation. If the GRV is elevated, the feeding may need to be held temporarily and rechecked later, following medical advice.
Step-by-Step Procedure for Delivery
Flush the tube with water to ensure patency before administering food or medication. Attach a 60-milliliter syringe to the feeding port and gently instill the prescribed amount of water, usually 30 milliliters or more. This step clears potential blockages and contributes to daily hydration.
Bolus feeding typically uses a large catheter-tip syringe attached to the feeding port, with the plunger removed. Hold the syringe upright and pour the formula in, allowing gravity to carry the nutrition into the stomach. Control the rate of delivery by raising or lowering the syringe. A typical bolus feed should take 15 to 20 minutes to complete, mimicking a regular meal.
Continuous feeding uses a pump and feeding bag to deliver formula steadily over many hours, often overnight. After filling and hanging the bag, the tubing must be primed to remove all air before connecting it to the PEG tube. The pump is then programmed with the rate and volume prescribed by the healthcare team to ensure steady delivery.
Administering medications requires careful attention to avoid tube damage or interactions. Only give one medication at a time. Pills must be crushed into a fine powder and fully dissolved in water before administration; liquid medications are preferred.
Never mix different medications together or combine them with the feeding formula. After each separate medication dose, flush the tube with a small amount of water. A final water flush is performed once all substances have been delivered to leave the tube clean and clear of residue.
Essential Daily Tube and Site Care
Maintaining the stoma site, where the PEG tube enters the body, prevents infection and skin breakdown. Clean the tube and surrounding skin at least once daily using mild soap and water or saline. Gently clean around the tube, including underneath the external fixation device or bumper, removing any crusted discharge.
After cleaning, thoroughly dry the stoma site, as moisture increases the risk of skin irritation and infection. Dressings are generally not necessary once the site has healed, unless instructed otherwise. Check the skin daily for signs of redness, swelling, or excessive discharge, which could indicate a developing infection.
Proper maintenance includes managing the external bumper, which holds the tube in place against the abdominal wall. Starting 10 to 14 days after insertion, the external bumper should be rotated or advanced slightly away from the skin and returned to its original position daily. This movement prevents constant pressure on the stomach wall, which can lead to buried bumper syndrome.
The external portion of the tube, including the clamp and the feeding port, requires daily cleaning with soap and water to maintain hygiene. If the tube has an external clamp, move its position slightly each day along the tube’s length. This practice avoids repeatedly weakening the tubing material, prolonging the tube’s lifespan.
Handling Common Complications
A clogged feeding tube is a frequent issue, often caused by inadequate flushing or medication residue. To resolve a blockage, attempt to flush the tube with warm water using a 60-milliliter syringe and gentle, pulsating pressure. Avoid excessive force, as this could damage the tube or stomach wall. If warm water fails to clear the obstruction, seek medical assistance for specialized declogging tools or tube replacement.
Leakage of gastric contents or formula around the stoma site can cause significant skin irritation. Causes may include a stretched stoma, a loose external bumper, or infection. Ensure the external bumper is positioned correctly and clean the area with mild soap and water to prevent skin breakdown. Persistent leakage, especially with pain or signs of infection, requires evaluation by a healthcare provider.
Signs of infection include increased redness, warmth, tenderness, and pus-like discharge. If these signs are present, focus on meticulous cleaning, but contact a medical professional promptly for assessment and possible antibiotic treatment.
Tube displacement is a serious event requiring immediate attention. If the PEG tube accidentally falls out, the opening can begin to close rapidly. The person must go to the emergency department immediately, even if the tube is reinserted, to ensure correct placement within the stomach and not the abdominal cavity.