Checking placement on a PEG tube?

Nurses General Nursing

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Is this necessary?

I was never taught this in school, but so far two preceptors have had me do it.

Specializes in LTC, med-surg, critial care.

For a new PEG I would wait for an x-ray.

Most of my patients have had their upwards of five years. I don't check placement with air with those patients. I check residual.

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have difficulty finding posting button or link despite exhaustive search. "new post" link gives exactly that, new posts. so, how can i post new article then?

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Specializes in Med/Surg.

When I was in nursing school, we were taught to always verify placement of a feeding tube by aspirating for stomach contents/residual. This is also the policy of the hospital where I work. But before a nurse can access the tube, there must be verification of it's location via x-ray, as well as orders from the doctor stating that the tube can be used for enteral feedings &/or med administration.

I don't know if this helps anyone, but here's what my Med/Surg nursing book says about checking the placement of a feeding tube:

"Assess tube placement by noting length of tube, aspirating stomach contents, and, if necessary, checking the pH of aspirate to determine gastric or intestinal placement. Recent studies show auscultation to be an ineffective means of determining feeding tube placement ." It goes on to say, "The ausculatory method of determining the location for feeding tubes...is commonly recommended in nursing textbooks and is frequently used...However, based on a series of studies(Metheny et al., 1998a), the auscultory method for determining placement is not reliable. This is especially true for small-bore feeding tubes...Nurses need to use alternative methods to auscultation to determine correct initial and continued placement of these tubes. Apiration of contents and pH testing may prove to be a more effective tool for determining tube placement."

(This information is taken from the text " Medical Surgical Nursing: Critical Thinking in Client Care", 2nd edition)

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Specializes in Medical-Surgical/Oncology.

I attend a nursing school in California and we are taught to aspirate the contents of the peg tube and check for placement. Usually patients take feeding via this route, and you want to make sure that the feeding is being administered to the stomach not surrounding tissues. You also aspirate to make sure that the patient is digesting so many cc's an hour. If the feeding is not being digested and the feeding is continued the stomach can become very distended can cause discomfort. That is what I know about feedings so far, but there may be other reasons to check for placement and aspirate for stomach contents. Also, this would be very important for a patient with a peg tube with bowel obstruction.

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In nursing school now, they said there has been evidence-based studies conducted where PEG tube placement should be checked each time you go to use it (ie. med administering, tube feed changes). You can check it by x-ray or pH testing of residuals. Bolus air is not adviced for PEG or NG tubes because either one can still hear the confirmation sound although it is in the lungs.

Remember to flush before and after and/or Q 4 hours to maintain patency. I've seen some nurses flush with tap water and some flush with sterile, but I personally don't plan on flushing with tap water due to pseudomonas in tap water. I plan to go to the kitchen and grab some filtered water if possible. :rolleyes:

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In nursing school now, they said there has been evidence-based studies conducted where PEG tube placement should be checked each time you go to use it (ie. med administering, tube feed changes). You can check it by x-ray or pH testing of residuals. Bolus air is not adviced for PEG or NG tubes because either one can still hear the confirmation sound although it is in the lungs.

Remember to flush before and after and/or Q 4 hours to maintain patency. I've seen some nurses flush with tap water and some flush with sterile, but I personally don't plan on flushing with tap water due to pseudomonas in tap water. I plan to go to the kitchen and grab some filtered water if possible. :rolleyes:

PEG tube isnt going to migrate to the lungs....auscaltating air for NG hopefully we can tell if it is being heard over the lung fields or the abd.....and tap water--if you drink it should be safe to use for flush.....

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The NG tube certainly can migrate to the lungs. The PEG tube can migrate to the peritoneal cavity. Mainly, these tubes can be in the wrong place and the air bolus can still be heard being pushed into the wrong anatomical regions.

As for the water for the PEG tube, it is a preference for each nurses and I would do unto others as I want other to do unto me, filter water for the PEG tube. Some people may argue that the stomach is acidic enough to kill any organisms, minus H pylori. However, some hospitals do prophylactically put PTs on PPIs to decrease stress ulcers, which detracts from bodily defenses. PTs tend to sleep on their backs quite a lot in the hospitals, which may lead to aspirations pneumonia. Pseudomonas is a bacteria that can possibly cause pneumonia.

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