Checking Placement of PEG

OhioMTCRN07 · Jul 20, 2007

No question asked is "stupid." That is how we learn new things -- nursing is constantly changing, updating based on evidence-based practices. Believe me, I have a lot of questions! Keep asking and keep learning!

hunny_pye · Nov 21, 2007

ingy, caring for people in their homes is a whole different ballgame than caring for someone in a hospital/snf.
as long as someone has a fdg tube, placement will always have to be checked.
it's just too darned easy for it to migrate.
were you the one who asked how to do it?
many nurses instill approx 10cc of air in the tube while holding the stethoscope over the stomach.
when you hear the 'whoosh', then you know the tube is where it should be.
a more reliable method is checking gastric pH, by aspirating a small amt of residual and placing it on litmus paper.
the pH should be less than 4.
the most reliable (and in some facilities, the only acceptable way) method is by xray.
don't hesitate to share any and all questions.
leslie

HI CAN SOMEBODY SEND ME A LINK TO THIS, THAT WE HAVE TO INSTILL AIR TO A PEG TUBE. I HAD A PT WITH PEG AND I CHECKED PLACEMENT BY INSTILLING 20 ML OF AIR THEN I ASPIRATED FOR RESIDUAL AND I GOT THE AIR THAT I INSTILLED BACK AND LIKE 5 ML OF RESIDUAL. THE PT COMPLAINED OF PAIN THAT SHE SAID SHE HASNT FELT BEFORE. A FAMILY MEMBER SAID THEY DONT INSTILL AIR AT HOME. I TOLD THEM ITS DIFFERENT IN AN ACUTE HOSPITAL, WE HAVE TO CHECK FOR PLACEMENT. AND AFTER THAT I PUT ONE MED IN, IT WAS LAKING WHICH SURPRISED ME. I TOLD THE PT I HAVE TO CALL THE DOCTOR AND INFORM HIM THAT THE PEG IS LEAKIN. WHEN I CALLED THE MD, MD SAID THAT IT HAS BEEN LEAKING. I ASKED IF HE WANTS AN XRAY, HE SAID NO NEED FOR THAT AND TO PROCEED WITH THE FEEDING. I WAS THINKING WHAT I DID SOMETHING WRONG TO MAKE IT LEAK, HAD RELIEF WHEN THE MD SAID IT HAS BEEN LEAKING. SO MY QUESTIONS, DID I DO THIS PROCEDURE RIGHT? H?W COME THERE'S PAIN? IS IT POSSIBLE TO PUSH "BACTERIA" IN WHEN INSTILLING AIR CAUSING INFECTION? :uhoh3: TNX!!!

SICU Queen · Nov 21, 2007

HI CAN SOMEBODY SEND ME A LINK TO THIS, THAT WE HAVE TO INSTILL AIR TO A PEG TUBE. I HAD A PT WITH PEG AND I CHECKED PLACEMENT BY INSTILLING 20 ML OF AIR THEN I ASPIRATED FOR RESIDUAL AND I GOT THE AIR THAT I INSTILLED BACK AND LIKE 5 ML OF RESIDUAL. THE PT COMPLAINED OF PAIN THAT SHE SAID SHE HASNT FELT BEFORE. A FAMILY MEMBER SAID THEY DONT INSTILL AIR AT HOME. I TOLD THEM ITS DIFFERENT IN AN ACUTE HOSPITAL, WE HAVE TO CHECK FOR PLACEMENT. AND AFTER THAT I PUT ONE MED IN, IT WAS LAKING WHICH SURPRISED ME. I TOLD THE PT I HAVE TO CALL THE DOCTOR AND INFORM HIM THAT THE PEG IS LEAKIN. WHEN I CALLED THE MD, MD SAID THAT IT HAS BEEN LEAKING. I ASKED IF HE WANTS AN XRAY, HE SAID NO NEED FOR THAT AND TO PROCEED WITH THE FEEDING. I WAS THINKING WHAT I DID SOMETHING WRONG TO MAKE IT LEAK, HAD RELIEF WHEN THE MD SAID IT HAS BEEN LEAKING. SO MY QUESTIONS, DID I DO THIS PROCEDURE RIGHT? H?W COME THERE'S PAIN? IS IT POSSIBLE TO PUSH "BACTERIA" IN WHEN INSTILLING AIR CAUSING INFECTION? TNX!!!

AAHHHHHHHHH!!! It's the CAPS LOCK key! :nono: Please use proper capitalization!!

I don't care for patients at home so I'm not familiar with the standard of care, but it seems to me if something's painful, then something's wrong. I'm sure the experienced home care nurses here can better answer the question.

CT Pixie, BSN, RN · Nov 21, 2007

It shouldn't be painful.

But we were taught to put 5-10ml air when checking placement d/t putting more might give the pt gas or get crammpy. Maybe it was the force of 20mL of air being put in?

As for bacteria being pushed into the stomach. Yes, you could ,but I don't think you have any more chance of pushing a bacteria in than you do handing a pt some water to swallow a pill.