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Percutaneous endoscopic gastrostomy (PEG) feeding tubes are used for enteral nutrition where service users are unable to maintain adequate nutrition through oral or nasogastric intake.



1. CONSIDERATIONS:


1.1 PEG tubes are used to access the gastrointestinal tract of service users who require nutritional support and have a functional, intact gut. PEG tubes are the preferred method for long term feeding.


1.2 Indications for long term intra-gastric feeding include:-


• Neurological disorders, e.g. CVA, disease of the central nervous system, unsafe swallowing

• Cancer of the head or neck

• Severe respiratory disease

• Severe malnutrition as a result of various disease states


2. CONTRAINDICATIONS TO PEG:


2.1 Adults - active coagulopathies, peritonitis, and any condition that precludes endoscopy.


2.2 Children - bleeding disorders, severe ascites, peritonitis, pharyngeal or oesophageal obstructions



3. ENTERAL FEEDING:

3.1 Equipment - The administration of enteral feeds may be via gravity drip or pump assisted.


3.2 Enteral Feeds - Commercially prepared feeds will be used for enteral feeding. Available in liquid or powder form, they have the advantage of being of known composition and are sterile when packaged. The dietician will agree the prescribed feed and the rate at which it is to be ingested.


4. PROCEDURE - FEEDING THE SERVICE USER:


4.1 Explain the procedure to the service user.


4.2 Sit the service user in a semi-upright position during feed to prevent regurgitation and possible aspiration.


4.3 Wash your hands thoroughly to prevent risk of infection. Flush tube with 30-50mls water both before and after every feed and drug administration to prevent blockage.


4.4 Connect giving set to tube. Set up pump at prescribed rate to ensure food is administered at the correct rate. Switch on and complete the feed, avoid total emptying of the feed bottle as air in the tube may enter the stomach and cause discomfort.


4.5 After feeding - The service user needs to remain in a semi-upright position for approximately 60 minutes to avoid aspiration.

4.6 Clean the tube after feeding by flushing it with 30-50mls of water or as prescribed.


4.7 Record in the care plan that the feed has been administered as prescribed.



5. PROCEDURE - BOLUS METHOD:


This allows set amounts of feed to be delivered via pump or syringe over short periods to stimulate “meal times”. However, it may increase the risk of aspiration and service users may complain of abdominal deterioration.


NB: Liquidised, ordinary food is not suitable for use in a PEG tube as the dilution required would result in an increased volume of less nutritious and possibly contaminated feed.



6. GENERAL CARE OF TUBE AND STOMA:


• Hygiene needs to be exemplary to avoid infection.

• To maintain skin integrity clean skin around tube under the bolster, with soap and water.

• To prevent adhesion, rotate tube twice daily.

• Check for signs of infection.

• Dressings are not recommended, especially below the bolster. Ensure tube is free from residue and remains patent.



7. POSSIBLE COMPLICATIONS:


• Risk of aspiration

• Risk of over-infusion

• Risk of sepsis at insertion site



8. CHANGE / REMOVAL OF TUBE:


As most PEG feeds are long term it is usual that tube changes are carried out at the local hospital.




FORMS REFERENCES:

Form No: 3-410 PEG Tube Feeding Record



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