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Peg Feeding Complication

Geriatric   (9,687 Views 11 Comments)
by NewlyGradBSN NewlyGradBSN (New Member) New Member

5,487 Visitors; 128 Posts

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My granny is confined at a long term care facility. She is on peg feeding. At one point, I saw the nurse teaching the new staff how to do PEG feeding. She accompanied her at least three times, observing her skills. Then, she allowed the newbie to do it on her own. I dont know how she came out short but when I arrived, after she fed my grandmother via PEG, I saw granny's head not elevated that much. Yes, the head of bed is elevated but she is positioned far down the bed that her head was elevated but her upper body wasn't elevated that much. Then I saw her burp and about 20-40 cc of feeding came out from her mouth. I know it is probably due to her position. After a while, I checked her vitals and they were stable. I complained to the resident and nurses on duty, but it was futile. They said that it happens. I am just wondering are there any complications due to this that threatens her life. Im a nurse but I only encountered PEG feeding during my years in nursing school.

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2,367 Visitors; 53 Posts

Very first thing that came to my mind was possible aspiration. She should have been assessed immediately IMO and should always be at a 45 degree angle at least.

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traumaRUs has 25 years experience as a MSN, APRN and works as a Asst Community Manager @ allnurses.

466 Likes; 14 Followers; 127 Articles; 184,827 Visitors; 20,485 Posts

I would continue to take this up with staff.

That said, your Grandmother can scootch down in bed too. This may have happened.

PEG tube feeds do automatically put the pt at risk for aspiration.

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tewdles has 31 years experience.

30,575 Visitors; 3,156 Posts

If it were my grandma I would have scooted her up in bed first and spoken to the staff later.

Would it be possible for grandma to get into a chair for her feedings?

If she routinely "burps" the feeding into her mouth I might question the volume of the feeding, or the time over which it is given.

You are correct to wonder about this. Your grandma could aspirate and I would consider her to be at risk for that complication based upon the scenario you described.

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5,487 Visitors; 128 Posts

I have taken this up to the staff and they didnt do anything. I dunno if they were too busy. I hated their attitude. She was assessed but they said I have nothing to worry about. Her vitals were normal, even her o2saturation. I wanted to know how long would signs of aspiration appear after such an event? what should I observe for?

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5,487 Visitors; 128 Posts

and when is the day that I can see that she is not at risk anymore? can this be also be fatal? I dunno if Im being paranoid here. I've seen and heard similar stories like this in the work place...

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wooh works as a RN & Critter Mama.

1 Like; 1 Follower; 1 Article; 37,328 Visitors; 4,383 Posts

She could have scooted down after the feed. And unfortunately, staffing at LTC doesn't provide for someone to stay in the room for a long time after feeds. But they did assess her and she was fine, so they reacted as they should.

Aspiration is a risk. It depends on how well she protects her airway as to how much of a risk. If it's an occasional burp, and she's fine afterwards (as she was this time) then not too risky. If it's a regular thing, then she might do better with continuous feeds or slightly smaller/more frequent feeds.

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232 Likes; 3 Followers; 95,207 Visitors; 36,400 Posts

My daughter's uncle died when he aspirated. I would take this very seriously.

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VivaLasViejas has 20 years experience as a ASN, RN and works as a Retired/Disabled Nurse and Blogger.

334 Likes; 8 Followers; 141 Articles; 247,020 Visitors; 9,526 Posts

As long as your grandmother has a PEG tube, she'll be at risk for aspiration. The risks can be minimized, of course, by a few common-sense actions such as never allowing feedings to run while she is laid down for incontinence care, keeping HOB at a 30-45 degree angle at all times while the feeding is running, auscultating Q shift to ensure that tube is placed properly, and turning down the volume of feedings if she isn't tolerating them well AEB burping and regurgitation. These are all standards of care that all LTC staff should know and implement; if there are problems, take your concerns to the RCM, the DON, even the administrator if necessary.

In the meantime, you may want to brush up on your own knowledge about feeding tubes......sounds like your grandmother will need you to advocate for her!

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arabstarRN works as a RN.

2,353 Visitors; 68 Posts

Anytime a patient is laid down past the 30 degree mark the tube feeding should be turned off to prevent reflux and aspiration of the feeding solution. It does sound like your grandmother may benefit more from smaller amounts doing her feeding or continuous feeding where she is given a much more manageable amount over each hour for a certain number of hours a day. 20-40cc doesn't seem like a lot when you think of it in a cup or something like that, but when you think of it in terms of what could potentially enter the lungs - it's a lot and way more than should ever enter the lungs! Even a little bit that gets in the lungs, especially of feeding solution, can cause big problems if bacteria grows due to the liquid within the lungs causing aspiration pneumonia. Your grandmother is at risk for aspiration, as stated by another poster, simply because she receives her food through a tube and I am guessing she doesn't have full swallowing abilities to help protect her own airway, which is why she's being tube fed (from what I understand, this is a common reason for a tube feed, among other major problems as well). Definitely pay attention and do what you can to get the staff to reassess her tolerance to the feedings, it could be as simple as a solution as changing the schedule of her feedings to include smaller more frequent feedings. It doesnt hurt to be the advocate, especially for a family member!

Good luck and I wish your grandmother the best, as well as you. You are right to be concerned, and if you approach the staff in a friendly, concerned manner rather than an accusatory manner, they may be more willing to reassess your grandmother's tube feeding schedule or ask the doctor what can be done to help with the reflux.

The elderly are notorious for sinking down in their beds (how I am not entirely sure, my father-in-law would get all twisted up and he had SEVERE left-sided weakness from a major right sided stroke, couldn't move left arm or left leg purposefully at all and very little non-purposeful movement). He ended up having to go to continuous tube feeding because he would reflux the formula and other times he would sink down and it would cause problems. Once they changed his tube feeding schedule, he was MUCH happier and better off, virtually no more refluxing and tolerated the feedings much better.

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5,487 Visitors; 128 Posts

My daughter's uncle died when he aspirated. I would take this very seriously.

can you share what happened? im bothered:(

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