peg tube placement

morte, LPN, LVN · Nov 18, 2007

then IGNATAVICIUS & WORKMAN owe me about $92 bucks!

whomsoever they may be, use your critical thinking, how would a peg tube migrate into a lung?

CT Pixie, BSN, RN · Nov 18, 2007

I think Nrs_Angie is speaking of

Medical-Surgical Nursing, 5th Edition - Critical Thinking for Collaborative Care, Single Volume

By Donna D. Ignatavicius, MS, RN, Cm and M. Linda Workman, PhD, RN, FAAN

kcalohagirl · Nov 18, 2007

that still begs the question, how would a PEG migrate to a lung?

Nrs_angie, BSN, RN · Nov 18, 2007

that still begs the question, how would a PEG migrate to a lung?

perhaps it could have punctured the tracheobronchial tree during placement

if I am wrong...sue me... but I will write a letter to the experts who wrote the book if it will make you feel better

and if morte can PROVE that an ET or PEG tube can't go into a lung... then provide the source where you researched this... just prove to me that it could never happen and I will throw this $92 book in the dumpster

additionally if Morte had such great critical thinking skills then he would know that HIGHEST concern of the RN should be SAFETY... we are required by law to practice SAFELY and COMPETANTLY... if there is the slightest chance... I dont care if its a 0.0009% chance... that the tube could be in the lung... it is OUR job to assess for placement!

Happy Holidays!

P.S. I also want my 50,000 grand back from tuition money at the school, where my Instructor had stated that there is a danger the tube could be in a lung.

Nrs_angie, BSN, RN · Nov 18, 2007

I think Nrs_Angie is speaking of
Medical-Surgical Nursing, 5th Edition - Critical Thinking for Collaborative Care, Single Volume
By Donna D. Ignatavicius, MS, RN, Cm and M. Linda Workman, PhD, RN, FAAN

BINGO! Paid $92 bucks for it. Thanks CTpixie

btw for those of you who have the book, you can refer to page 1370, under the heading Complications of Total Enteral Nutrition

morte, LPN, LVN · Nov 19, 2007

BINGO! Paid $92 bucks for it. Thanks CTpixie
btw for those of you who have the book, you can refer to page 1370, under the heading Complications of Total Enteral Nutrition

the only time it could be in a lung would be on placement which is a moot point to the nurse on the floor....as placement would have been ascertained by xray before use.....since i have never worked in endo, dont even know if it is possible to have it happen then......use your critical thinking skills, how is a soft latex tube going to go from the stomach...to a lung?it isnt long enough to go up the esophagus and back down.....and isnt going to puncture the stomach, the diaphragm and a lung.

please feel free to write to those authors, i would be interested to see their explanation.

rnmi2004 · Nov 27, 2007

An NG/OG tube could migrate to the lung; therefore, checking placement is necessary.

Have you ever seen how short a PEG/PEJ tube is?

http://www.pedsurg.ucsf.edu/gastrostomy_tubes/images/main_img.gif

I'm not sure how it would migrate up the esophagus and down the lung.

I was taught to check placement for a PEG/PEJ but, unlike everything else I learned, I was never taught any rationale. If the PEG/PEJ is dislodged just enough that you can't tell from visual inspection, I'm not sure how you might know it is no longer in the correct position.

meownsmile, BSN, RN · Nov 27, 2007

I have to concur with RNmi. I think when you are referring to the book and enteral feedings your book is explaining the placement of a naso-gastric tube which is completely different from a PEG. A PEG is a percutaneous tube placed through the abdomen and into the stomache. For a PEG to migrate to the lung it would as someone else said have to be completely sucked into the stomache and move up the esophogus to the trachea and go down. A PEG tube normally is no more than the length of a foley catheter. Or it would have to have punctured the diaphram on insertion to get to a lung. If it had the patient would immediately go into respiratory distress in surgery and you wouldnt see the patient back on the floor until the chest tube was out and the lung reinflated.

Dont throw your book away, and noone is trying to push any buttons, but i think you may have misunderstood your book.

morte, LPN, LVN · Nov 27, 2007

I have to concur with RNmi. I think when you are referring to the book and enteral feedings your book is explaining the placement of a naso-gastric tube which is completely different from a PEG. A PEG is a percutaneous tube placed through the abdomen and into the stomache. For a PEG to migrate to the lung it would as someone else said have to be completely sucked into the stomache and move up the esophogus to the trachea and go down. A PEG tube normally is no more than the length of a foley catheter. Or it would have to have punctured the diaphram on insertion to get to a lung. If it had the patient would immediately go into respiratory distress in surgery and you wouldnt see the patient back on the floor until the chest tube was out and the lung reinflated.
Dont throw your book away, and noone is trying to push any buttons, but i think you may have misunderstood your book.

thank you. thank you. thank you.

TraumaGirl1018 · Nov 27, 2007

i dont see how in the world a PEG tube would migrate to the lungs...even if by some chance a lung was inadvertently pierced during PEG placement, it would be noticed pretty quickly..and even so, that wouldnt be considered "migrating", because it never "migrated" anywhere, it was directly placed there. By the time a pt with a PEG tube in a lung got to the floor, they'd probably be in serious trouble

shrimpchips, LPN · Nov 29, 2008

that still begs the question, how would a PEG migrate to a lung?

It wouldn't.

The PEG tube can migrate to the duodenum, however. That's why you should check placement by injecting air into the tube to listen for that gurgle. Of course like Nrs_angie mentioned, the most reliable way to check placement is by xray. Another very reliable way is to check pH when you aspirate for residuals - the duodenum has a pH of ~6-6.5 while the stomach has a pH of ~1-2.

catlvr · Nov 30, 2008

THanks; there's a fair amount of dispute in our facility about where to place the stethoscope to determine placement - we all have a differnt idea! I'd love to find the "definitive" answer, since our facility policy doesn't offer it, and I haven't been able to find the answer.

TIA,

e

It wouldn't.
The PEG tube can migrate to the duodenum, however. That's why you should check placement by injecting air into the tube to listen for that gurgle. Of course like Nrs_angie mentioned, the most reliable way to check placement is by xray. Another very reliable way is to check pH when you aspirate for residuals - the duodenum has a pH of ~6-6.5 while the stomach has a pH of ~1-2.