PEG tube leaking

[limabean]

I had a pt today with a peg tube that had some leakage around the site. A KUB had been done yesterday and it showed the tube to be in good position. Well when I changed the dressing there was what looked like some tube feeding around the site and on the dressing. Then later when I gave a med thru the tube (which was red), I decided to see if it was still leaking. Sure enough when I lifted the tube upward the red drainage started seeping out. The surgeon had come by early am and had commented in the progress notes "No drainage around g-tube site". (Which by the way wasnt true b/c I changed the dressing about 30 mins later). So I called the doc on call and he said he thought it was alright and that the other surgeon would re eval in am. My question is...how much is too much drainage from the peg tube site? What could be causing this? Thanks.

[leslie :-D]

his bowel sounds are all positive?

no residuals?

no abd distention?

leslie

[KellieNurse06]

Have you checked the balloon to make sure there is enough filling the balloon to keep it in place? If so, are they using normal saline because the sodium tends to weaken the balloon and it will eventually get deflated........I only put sterile water in the balloon of a gt......

How about the diameter of the tube? Is it wide enough? It could be that the patient just needs a little wider diameter tube............

Also....have you vented the tube? Sometimes gas pressure can build up & what can happen is the old "path of least resistance" .....if pressure is built up, something has to give...and the fluid may escape around the tubing. You'd be surprised at the amount of people who forget this one little thing that can do alot for the patient... Just remember ......gtube patients need to burp too! It is very painful to them with the gas pressure in their bellies..

Good Luck!

[leslie :-D]

i was thinking of the balloon also, but then i thought that peg tubes were sutured in.

which type of tube can be replaced at the bedside and the other type, back to the o.r.?

if it is a tube with a balloon, then maybe it needs a 30cc?

i'm curious to hear what the surgeon says.

leslie

[KellieNurse06]

i was thinking of the balloon also, but then i thought that peg tubes were sutured in.

which type of tube can be replaced at the bedside and the other type, back to the o.r.?

if it is a tube with a balloon, then maybe it needs a 30cc?

i'm curious to hear what the surgeon says.

leslie

Oh Ya!! Great point!!! I forgot that surgeons usually do suture the tube in place......(owwww!!) I think the tube that can be done at the bedside is the foley cath type.....am I correct???

[mel1977]

we have some pts with balloons (foleys) as their tubes. It is very rare where I work for a gt to leak AROUND the tube. We do a gastrography study which is much more conclusive than KUBs, but I am not sure what the policy is where you are. Could there be a puncture in the tube its self?

[catlady, BSN, RN]

i was thinking of the balloon also, but then i thought that peg tubes were sutured in.

which type of tube can be replaced at the bedside and the other type, back to the o.r.?

if it is a tube with a balloon, then maybe it needs a 30cc?

i'm curious to hear what the surgeon says.

leslie

PEG tube placement is a surgical procedure. There's not much a nurse can do with a PEG site other than keep it clean and dry. If it's leaking, the physician should be notified. Since the OP already did that, she can't do a whole lot else other than keep changing the dressing and documenting what she sees until the doctor comes in to look at it.

If it's a Foley, it should already have been a 30 cc balloon.

[leslie :-D]

no- gastrostomy tubes w/balloon are not the same as foley caths.

if a pts' g-tube needs changing, we usually stick a foley in until the g-tube arrives from pharmacy.

stomas close up incredibly fast so it's imperative a foley is inserted, to prevent another surgical procedure.

the g-tubes i have worked with, come w/10cc and 30cc balloons.

what i get confused about, is when a gastrostomy is being done in prep for enteral fdgs, there is a procedure where the surgeon sutures the g-tube in.

i thought that was the peg (percutaneous enteral gastrostomy?).

these cannot be changed by nsg. it is solely a surgical procedure.

the other procedure is once the gastrostomy is done, then the g-tube w/balloon is merely inserted, balloon inflated.

it can be changed by nsg prn.

anyway, i was confused as to what exactly a peg tube was. :)

leslie

[catlady, BSN, RN]

Here are some pictures of different type of tubes:

http://www.cysticfibrosismedicine.com/htmldocs/CFText/feedpicgal.htm

[Antikigirl, ASN, RN]

I have seen leakage in good tubes before in newly established tubes...sometimes it is the placement of the end pushing against the sides of the stomach just by body position. What I try to do is have the pt sit up for 30 minutes after each feeding/med/flush. Sometimes that fixes the situation and then I know it is positional.

But if that doesn't work, sometimes it is swelling too. I KEEP the dressing so I can show the MD and mark them with time of change. That way if there is no active drainage right then and there when the MD comes...they have a reference to go by. I will also document about how much was on the dressing...like quarter size, dime sized...its an estimate and the color and smell too if it is unsual. (cause either way...pewwwwwwww!). Another handy trick..mark the times on the dressings when you applied and removed so leakage speed is recorded!

Of course, trying to be there with the MD at the time is premium...but not very possible some times with the way they pop in and out like a ghost! LOL!

Most of the ones I have even encountered are sutured, but I have had to watch a actual foley put in till they could get the pt into surgery to put in another. This is a temp urgent/emergency thing in our facility. (The patient coughed really hard and blew the sutures...ouch!!!!!! Freaked me out! LOL!).

Either way it goes, keep that area clean and dry as possible to keep from getting any further skin errosion or damage (that will make more leaks and/or infections).

[morte, LPN, LVN]

hmm didnt look it up but i think..

1)PEG ..percutaneous endoscopic gastrostomy

2)PEJ ..percutaneous endoscopic jejuenostomy

need to make sure which one you are dealing with......how old is it....has it ever been forceably "unblocked" or invasively "unblocked"..? which mght hint at a rupture of the tube....presumming that it is a PEG, try positioning pat. on his/her rght side ,...

in the short term, about the only thing to do is as stated above, keep the area as dry and clean as poss... good luck

[not now, RN]

If it's a PEG that is sutured in place then catlady is correct and the MD will have to come in and deal with the problem. Just keep documenting and let the MD know what's going on. Does it have the round disk that rests against the abdomen keeping it in place?

If it's a GT with a foley in place, peristalsis(sp?) may be pulling the foley down thus the balloon may not be resting against the abdominal wall allowing contents to leak out the stoma. To fix this we usually take a washcloth, fold it in half, roll it up, wrap the excess foley tubing around it and tape it on to the washcloth. (Make sure the foley has been pulled until resistance is met so the balloon is against the abdominal wall.) This prevents the excess tubing to pulled in. You can also cut a hole in a pacifier and pull it through but finding a pacifier where I work isn't gonna happen.

I've worked both long term care (GT's for years and years) and subacute (30 patients, 28 with GT's!) and for some reason the PEG doesn't stay in long. After a while it's replaced with a 20 or 22 Fr foley catheter making it easier for the nurse to replace when clogged or those rare occations when a confused combative resident thinks pulling out her own PEG/GT (With the balloon inflated. Ouch.) is a good way to get back at us. This way we aren't calling the MD at all hours and sending them out via ambulance just to replace a PEG.