Checking placement on a PEG tube?

[Skwidward]

Is this necessary?

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

[sweetieann]

I myself was always confused on this. My rule of thumb is ALWAYS check on NG. Never check on NJ tube or ND tube....also NOT neccessary to check placement for peg tube (aka gastrostomy tube), and doing so is not in any policy and procedure manuals I have come across. Still, I have seen some nurses do air aucultation to check peg placement, not sure why.

ps-that being said, i would check a residual, just to make sure stomach is digesting the feed in regards to the peg...

[RN1989]

Yes. And document this to prevent problems later when pt's families try to sue for issues relating to tube/feedings.

[EmmaG, RN]

I myself was always confused on this. My rule of thumb is ALWAYS check on NG. Never check on NJ tube or ND tube....also NOT neccessary to check placement for peg tube (aka gastrostomy tube), and doing so is not in any policy and procedure manuals I have come across. Still, I have seen some nurses do air aucultation to check peg placement, not sure why.

Because PEGs can become dislodged, leading to some nasty peritonitis.

[leslie :-D]

Yes. And document this to prevent problems later when pt's families try to sue for issues relating to tube/feedings.

yes, to the above!

if anything else, you will have at least, confirmed placement and patency, to the best of your ability.

i'm not sure why schools aren't teaching this today?

but i will tell you, i have had gtubes go bad.

and it was through the steps i took, before administering fdg/meds, that i discovered the failures.

in such a litigious society, it would certainly benefit you to confirm the viability of a fdg tube.

leslie

[plumrn, BSN, RN]

How do you test a peg tube for placement? A bolus of air? If so, wouldn't you hear the air even if it wasn't in the stomach? We always check for residual, but I've never checked any other way.

Someone teach me something here. I'm embarassed that I didn't know this.

[sweetieann]

this was exactly my thoughts....

[HenryH0]

We always confirm placement on all tubes such as these not only through a bolus of air but always with an x-ray before using the tube. This is to ensure that we are not in a lung. Once the tube it confirmed as placed, the md calls and tells us to advance it or retract it such and such a length it is measured so that we can ensure that it doesn't move over time. If it is an intermittent feed it is measured each time we hook it up and if it is a continuous feed it is measured once a shift and anytime that the nurse suspects that it may have moved (like if the tape has come loose)

[morte, LPN, LVN]

g tubes of whatever "flavor" (mode of placement) if you instill air you will hear it, even if the tube is not in stomach...it will be somewhere in the peritoneal cavity...it isnt going to be in a lung......so it doesnt apply....if it has been "sucked in", it is prob in the small intestine and is prob a tube with a balloon on the end.....check wth p+p, if you simply deflate the balloon and pull back or contact md. ...i wasnt taught to check placement on a gt either...25 or so years ago, this applies to NGtubes...if you really want to check for placement you could check aspirate for pH....residual is another issue,lol

[jmgrn65, RN]

checking for residual will check for placement in PEG tubes.

[morte, LPN, LVN]

checking for residual will check for placement in PEG tubes.

only if you check pH

[Nurse Lulu]

No! Placement where I work is checked via x-ray and NOT by air bolus. GI gets real mad about this. Checking placement can damage the tube and residual is to be checked passively (by putting it over a graduated cylinder, NOT by pulling back). The standing orders for every doctor are written this way. Apparently this is not universal though.... Note this does not include NG's etc....CAT