what to do when a PEG comes out

[fusster]

Had a pt the other day who's PEG came out on the shift before mine. The nurse called the doctor, and he said to insert a foley into the hole in the abd wall, then to resume the tube feeding through the foley, and he would be in tomorrow to insert a new PEG. She wasn't comfortable putting a foley in, so she tried (not very hard), and said she felt resistance, so the foley was not put in. She wasn't able to get a hold of the doctor (community hospital, no residents or anything, just the attending who doesn't always call back). I wasn't comfortable with it either, so I didn't even try. The doctor was very angry when he came in and there was no foley in. Any of you ever heard of putting a foley in a PEG hole? Is this even within our scope of practice? Sounds kinda invasive to me, and I don't like the idea of infusing the tube feeding when we dont have any kind of test to show where the catheter would reside. Honestly, I'm not even sure how that setup would work.

[leslie :-D]

always, always put a foley in, if unable to replace gtube at bedside.

these stomas close very quickly, necessitating another surgical procedure for the pt.

you check for placement same way as you do a gtube.

that's unfortunate your pt will have to endure another gastrostomy.

leslie

[sweetnoel]

Yep. Foley's are best when g-tube comes out.

[TheCommuter, BSN, RN]

Any of you ever heard of putting a foley in a PEG hole?

One of my patients has a 15FR (french) sized foley catheter as his feeding tube. I've seen more patients with foleys being used as g-tubes than I've seen real g-tubes.

At the last nursing home where I was employed, there was a standing order on all feeding tube patients to replace their g-tubes PRN. In other words, the nursing staff did it unless some other complication arose that necessitated the patient to be sent to the hospital to have the tube inserted.

[BerryHappy]

Yup, PEG out? Foley in! The only way to go! It is bad when the pt has to go through surgery all over again. It sounds bizarre I know, but remember the point is to keep the opening OPEN.

Sorry kiddo!

[fusster]

He didn't have to have another gastrostomy, the stoma was still open (luckily). So, if this happens again, I would insert the foley, inflate the balloon, secure it with tape, unhook the collection bag, verify placement, and put the tube feeding tip into the foley tubing? Does this sound right? This is something they definately did not teach me in nursing school.

[steelcityrn, RN]

Perhaps you had the gastric tube(peg) confused with a j tube. It is within your scope of practice to drop a new catheter in the stomach for feedings/h2o and meds. I agree, your delay could have caused harm to the patient.

[fusster]

I agree, your delay could have caused harm to the patient.

The nurse before me never wrote out the order to put the foley in, or even charted that he said to put a foley in, and I was unable to contact the doctor.

[jessiern, BSN, RN]

I would also add that in the future if something like this comes up, and you are not comfortable call to someone with more experience like a supervisor, or nurse manager.

Better to look less knowledgeable then to cause harm to a patient.

[catlynLPN]

I have also had experience with these peg tubes and we were inserviced on what to do if a peg came out, upon our first patient having this procedure.

Foleys are what you do. A small one is better than none.

One came out of one of our patients once, and BEFORE I could get there, the hole had already somewhat closed or it was very small to start with.

Also, if NOTHING else, and you still have the peg tube, cut the bulb off and wash it good, and then insert that back into the opening and tape it to the abdomen. I've had to do that before.

And you know that those are the same size as the opening, or should be if you don't delay getting to the patient to insert it.

[fusster]

ok, thank you all for your advice. I've been a nurse for less than a year and had never encountered this situation before. I followed the lead of the preceding nurse who had 20 years experience, but I guess she was wrong. Lesson learned!

[caliotter3]

I never heard of using a foley for a g tube either until I saw my first resident with one. A g tube had come out and the nurse on duty replaced it with a foley because there wasn't a replacement g tube available. The resident ended up keeping the foley. I thought it looked weird, but it worked. The nurse explained to me that this is really quite common.