PEG tube replacement

[Anne36, LPN]

A little background first, Im a new Grad LPN working in LTC, in school the subject of PEG tube replacement never came up, I am not trained to do it and the one thing that does stick out was that we were told to get x-ray confimation of placement before using a new PEG tube. Recently a couple of different Nurses have replaced a PEG tube, , Nurse #1 got x ray confirmation of placement, Nurse #2 said it was not necessary. I have 2 questions, Is replacing a PEG tube within my scope of practice? ( I dont have any type of training), Do we need x-ray confirmation of placement? I feel very uncomfortable if I ever have to do this procedure, and I felt more uncomfortable running a tube feed without x-ray confirmation. What if the feeding went into the peritoneal cavity? An infection could result, leading to surgery or death? There is never anyone in management when I am working to ask these types of questions until I am coming off of my shift.

[FLArn]

Back in the day we replaced them all the time using catheters if we didn't have replacement feeding tubes. No xrays just obtaining residual to check placement. Then a few years ago we were told we had to send patients to ER for feeding tube replacement.

[LTCNS, LPN]

I am a LPN and am certified to replace peg tubes but haven't had to do it for some time now. I never needed an x-ray to confirm placement. Just had to listen with a stethoscope and check residual. Oh, and regular foley caths were used if no peg tubes were available.

[amoLucia]

Once the first surgical PEG tube has been replaced by the MD, I've changed GT tubes freq without problem. Just checked for placement by auscultation and residuals. Only reinerstion problem I've ever encountered was inability to deflate the balloon when an old GT was clogged and I just couldn't declog it. And I DO know all the tricks - it seemed to happen only when the current tube was an old one that hadn't been changed in a while.

However, on the wrapper for foley catheters (the one that has the size that we peel back and discard) it clearly says "FOR UROLOGICAL USE ONLY". There is product liability if injury occurs when a foley is improperly used for Gt replacement. To keep the stoma open, I have used a FC in a pinch, but it gets changed as soon as the right Flexiflo (or other) tube was obtained.

To OP - since you have neither the education nor experience to change GTs, you shouldn't be doing them without someone there with you. They're not difficult. But you need to check your facility P&P for technique and permission for LPN vs RN (and your state Practice Act).

[wooh, BSN, RN]

Check via residual. That's what I've always done.

But depends on your facility's P&P.

[NurseCard, ADN]

There are different types of tubes, and I'm ashamed to say I still get confused.

I have one resident who has a GT tube... it clogs up about once a week for reasons

I'm still not clear on; I've heard nurses say that his tube is too narrow and he needs

a bigger French.. I've heard other nurses say that he's not getting flushed often

enough. Maybe it's a little bit of both. Anyhoo, I am constantly having to change

his tube. I pull the old tube out, stick the new tube in, auscultate, check for

residual, blow up the balloon, flush, hook up the tube feeding. Easy peasy.

I have another resident with a surgically placed PEG tube. We still auscultate

to check for placement. Her tube clogs up but is much easier to unclog than the

GT tube; it's a much more flexible tube.

So what exactly is the difference between these tubes? They both go in the

stomach, but why is one surgically placed and stitched in and the other not?

[amoLucia]

In all my experiences, the priority, #1 reason for tubes to clog is a failure to adequately flush frequently enough. Second reason is the attempt to put meds (or something else) too thick to go down the tube and thus it occludes.

IVs and tubers are among my first visits when I start my rounds and I do them freq. And they're usually my last. No one is ever surprised coming behind/after me and finding a clogged tube --- unless I have a problem one that I couldn't manage (and then they know about it).

[Rach823RN]

I have a resident who constantly pulls his out. The RN does replace it, then we must send him to the ER (literally across the street) for a gastrograph aka X-ray to check for placement BEFORE feelings resume. But please CYA and double check your policy! And, FYI keep a spare in the fridge, they go in easier when they're cold and firmer! HTH!

[Rach823RN]

Also, just remembered... Tube clogging could be due to decreased peristalsis. But really there are many variables about the specific resident... Check that bowel movements are frequent enough. If the resident is end-stage, like mine, we do rectal tubes and tap water enemas to clear him out constantly. Avoids frequent aspiration pn as well!

[cabbagee]

How did you obtain certification?

[CapeCodMermaid, RN]

We don't get an x-ray. Had a woman who pulled out her tube at least 4 times a day (family didn't get it....said she really wanted it)---look at your facility's policy.