A Percutaneous Endoscopic Gastrostomy (PEG) tube is a flexible feeding device inserted through the abdominal wall directly into the stomach. This tube provides a pathway for delivering liquid nutrition, hydration, and medications when a person cannot consume them safely by mouth. Individuals who have difficulty swallowing, often due to neurological conditions, head and neck cancers, or severe trauma, rely on a PEG tube for nutritional support. The PEG tube ensures patients receive consistent caloric intake and remain properly hydrated.
Preparing for Safe Administration
Before beginning any administration, meticulous hand hygiene is necessary to prevent introducing pathogens. Gather all required supplies, including the prescribed enteral formula, warm water for flushing, and the appropriate syringe or feeding bag setup. The formula should be at room temperature, as cold formula can cause stomach cramping.
The patient must be positioned with their head and shoulders elevated to at least a 30- to 45-degree angle, or placed in an upright chair. This position helps prevent the reflux of formula and should be maintained for at least 30 to 60 minutes after feeding to minimize aspiration risk. Visually check the tube placement and security before use, ensuring the external fixation device (bumper or crossbar) sits snugly against the skin.
If advised, check for gastric residual volume (GRV) by gently aspirating the stomach contents using a syringe. This assesses stomach emptying between feedings. If the aspirated volume exceeds the patient’s care plan limit, the feeding should typically be paused or held, and the contents returned to the stomach. High residual volumes indicate delayed gastric emptying and warrant immediate communication with the clinical team.
Detailed Procedures for Feeding and Medication
The first step in any PEG tube administration is flushing the tube with a specified volume of water, usually 15 to 30 milliliters. This initial flush clears any stagnant material and confirms the tube is patent. Water flushes are the primary defense against tube occlusion, a common complication that limits the tube’s function.
Bolus feeding simulates normal meal consumption by delivering a set volume of formula over a short period, typically 10 to 20 minutes, using a large syringe. After connecting the syringe, the formula flows by gravity, with the height of the syringe controlling the rate. Avoid pushing the formula forcefully, as rapid infusion can cause cramping, diarrhea, or nausea.
In contrast, continuous feeding administers formula slowly and consistently over many hours, often using a specialized enteral feeding pump. This method is preferred for patients who cannot tolerate large volumes at once or require strict control over nutrient delivery. The pump is programmed to deliver the formula at a precise rate, ensuring a steady, gentle delivery.
Delivering medication requires careful preparation to ensure proper absorption and prevent clogging. Only liquid medications or tablets that can be properly crushed and fully dissolved in water should be administered. Capsules must be opened and their contents mixed thoroughly with water. Never crush enteric-coated, sustained-release, or sublingual medications unless authorized by a pharmacist, as this alters their intended action.
Each medication must be administered separately to prevent interactions that could lead to precipitation or tube clogging. After drawing the dissolved medication into a syringe, deliver it gently into the tube, followed immediately by a small water flush to push the drug into the stomach. A final water flush must always follow the administration of the last dose or the completion of a feeding session. This final rinse removes residual formula or medication, minimizing bacterial growth and preventing hardening within the tube.
Daily Tube and Site Maintenance
Routine cleaning of the stoma site is paramount for infection prevention and skin integrity. The site should be gently washed daily with mild soap and warm water, focusing on the area around the tube insertion point. Use a clean, soft washcloth or gauze to remove any crusted drainage or residue.
Following the wash, the area must be thoroughly dried, as moisture trapped beneath the external fixation device can foster bacterial growth. If directed, a split gauze dressing may be placed around the stoma to wick away moisture and protect the skin. Inspect the skin for any signs of irritation, such as redness, swelling, or rash.
If directed, the tube should be rotated slightly each day. This prevents the internal bumper from adhering to the gastric wall and helps distribute pressure evenly around the stoma, reducing skin erosion. Ensure the external bumper is snug but not constricting to maintain the proper seal and prevent leakage.
When the PEG tube is not in use, it must be properly secured to the patient’s clothing or abdomen using a specialized tube holder or medical tape. Proper securement prevents accidental pulling or tension on the tube, which could lead to internal trauma or dislodgement.
Troubleshooting and Recognizing Complications
The most common issue encountered is tube occlusion, which can often be resolved by gently attempting to flush the tube with warm water using a back-and-forth motion with the syringe plunger. If water fails, a small amount of a carbonated beverage or a prescribed pancreatic enzyme solution may be used to dissolve the blockage. Minor leakage around the stoma can be managed by ensuring the external bumper is properly positioned or by applying a thin layer of protective skin barrier cream.
Recognizing signs of serious complications requires vigilant observation of the patient and the insertion site. Signs of a localized infection include:
- Increasing redness.
- Warmth.
- Significant swelling.
- Foul-smelling, purulent discharge from the stoma.
Patient symptoms like persistent nausea, vomiting, abdominal pain, or a fever may indicate a systemic issue or a complication such as peritonitis.
Certain events require immediate contact with a healthcare provider or emergency services. If the PEG tube accidentally falls out, a new tube must be reinserted promptly (within one to two hours) as the stoma tract can close rapidly. Medical emergencies signaling potential intestinal obstruction or perforation include:
- Severe, worsening abdominal pain.
- Signs of peritonitis (a rigid, tender abdomen).
- Inability to pass gas.
- Inability to have a bowel movement.