PEG/PEJ placement

[SerenaT]

Hi,

I am not a GI nurse specialist, but was hoping to get some accurate info from nurses who specialize in Gastro. I am embarassed to ask this question, however it has been driving me crazy. Here it is...

A PEG and/or PEJ tube is in place. How do you assess the proper placement of the tube prior to a giving anything thru the tube?

I always thought it was by measuring the the lenght of the external tube. Now somebody is telling me you insert air to here the sounds just like a NG tube. Thanks in advance for your help.

SerenaT

[CoffeeRTC, BSN, RN]

In LTC we insert air and listen over the belly. you can also try to aspirate some stomach fluids (my not have any residuals tho) or when needed get an Xray??

[nursedawn67, LPN]

In LTC we insert air and listen over the belly. you can also try to aspirate some stomach fluids (my not have any residuals tho) or when needed get an Xray??

This is what I was always taught too.

[Kyli]

that's what I was taught too.

[SerenaT]

O.K.

So then you are saying people at home always check for air before they do their own feeding?

SerenaT

[memphispanda, RN]

We teach patients or family members to aspirate for stomach contents. Heck--air could go anywhere and make some noise that the family may or may not recognize as proper or improper placement. Who knows if they actually check at home though--teaching covers your rear in case the tube comes out and they start running a feeding into the peritoneum instead of the stomach or jejunum.

[SerenaT]

We teach patients or family members to aspirate for stomach contents. Heck--air could go anywhere and make some noise that the family may or may not recognize as proper or improper placement. Who knows if they actually check at home though--teaching covers your rear in case the tube comes out and they start running a feeding into the peritoneum instead of the stomach or jejunum.

I also heard (was told) that especially with the PEJ you could cause peristalisis to cease. Still lookiing for written documentation. Thanks to all for your input.

SerenaT

[Chuckie]

This isn't what was asked, but I was wondering if nurses are doing the cuts on the PEG placements in other parts of the country. We do the cuts but we need an extra RN in the room for CS.

[chrisf1969]

A reply from the UK.

To ensure correct peg placement, after the peg is inserted, OGD is repeated and a photograph is taken by the endoscopist to show placement. This is whjat we do in the theatre, however i am unsure what they do on the ward.

[donmomofnine]

On a side note, I was noticing lately that PEGs are always used and no longer are foley feeding tubes used. If there is a problem with a PEG, the resident has to go out to have a replacement. With the foleys, the staff could just reinsert a new tube. Do any of you know why the shift away from foleys, or is it just my imagination? thanks!

[MQ Edna]

This isn't what was asked, but I was wondering if nurses are doing the cuts on the PEG placements in other parts of the country. We do the cuts but we need an extra RN in the room for CS.

I do Pediatric GI. When I started, I was doing the cuts for the PEG Placements. Then I was told by my hospital administrator, that was not in my scope of practice. I could get sued or fired. Guess what... I don't do that anymore. It is extremely difficult since we only have 2 MD's, no fellows and the docs want us to do it but it is my license. Check with your Board of Nursing before you do it, different states may have different rules.