PEG Help Please

[Bec717]

Yesterday, at 1400 went to change TF and plan flush/residual check. Tube would do neither. Tried the Coke, ordered a PEG brush from central, repositioned patient. Nothing worked- Charge RN came in worked with the PEG- nothing.

Called the MD- he could not get the PEG to work- ordered KUB- only showed gas present.

I completed shift as he was ordering a CT scan.

Patient had AM BM and another during KUB- checked for impaction, denied any n/v/pain. At AM assessment, checked for placement and BS- all good, abdomen round, soft. Did note at 1400 abdomen becoming distended and firm on side with PEG tube.

When you have a clogged PEG, any other suggestions on what to do, other than what I did?

Thanks!!!

[Forever Sunshine, ASN, RN]

60cc piston syringe with warm water. and flush it through .. not by gravity.. by the plunger.

[jrsmom58]

No. It probablyPeg for needs to be replaced.. I have a Pt that has had a peg for mant years..I do home care.. the older peg materials were better.. Nurses and myself have alot of trpuble with the one she has now..adjusting etc..I have 30 yeasrs exp....you did the right thing

[Bec717]

Thanks- tried that- the fluid would go about 2 inches into the tubing- so placed Coke for 20 minutes- the brush would go to the bumper and of course I did not go any further.

At one point when the Charge RN was trying- about 2 inches closest to the syringe placement the tube actually started to balloon- really weird- brush would go through with no resistance- no flush and when we tried to pull residual the tube would collapse-

we rolled the tube, tried to gently milk it, there was no hard areas of tube feed-

The MD came in an adjusted the bumper- gently moved the tube up and down- he was even baffled as to why the tube would not flush or aspirate- as the tube was clean and clear from the bumper out- so thinking either a SBO or the tube had compressed somewhere?

He was planning a CT and at that point a new PEG placement- just wish for the patient we could have found a better solution to get the PEG to work again!

The patient had a Kangaroo pump set the do a 125 ml flush every 8 hours, however I don't trust those, so glad I took the time to actually stop the TF and check for flush/residual, as the PM RN told me she had not done this, since the Kangaroo was set to flush- I prefer a hands on for PEG rather than the Kangaroo!!

[Esme12, ASN, BSN, RN]

I have seen meat tenderizer work .... it breaks down the protien. Sometimes they just need to be relaced....

[shiccy]

They used to use meat tenderizer all the time, though they don't anymore. When they told me that and knowing what that does to beef at home, all I could think of was, "YOU USED WHAT?!" I remember a case or two where a PEG migrated (it was attached too tightly and eroded the inner portion of the stomach) and the TF was extravasating into the abdominal parenchyma. I can only imagine if that person had a PEG clog and they tried meat tenderizer!

I've had the most success with Coke. Please note that you can NOT use diet coke in place of this. You have to be persistent and push and pull every 10-20 minutes until it unclogs. I've fought with plugged NG's, PEG's, and J-tubes for the better part of the shift to attempt to get them unclogged.

I've found that this is typically due to people being lazy and NOT flushing them when they should be. J-tubes are a little worse, and sometimes MD's even say, "No meds per J-tube" because they clog so easily, but typically PEG's aren't as much a problem.

[nursynurseRN]

Yesterday, at 1400 went to change TF and plan flush/residual check. Tube would do neither. Tried the Coke, ordered a PEG brush from central, repositioned patient. Nothing worked- Charge RN came in worked with the PEG- nothing.

Called the MD- he could not get the PEG to work- ordered KUB- only showed gas present.

I completed shift as he was ordering a CT scan.

Patient had AM BM and another during KUB- checked for impaction, denied any n/v/pain. At AM assessment, checked for placement and BS- all good, abdomen round, soft. Did note at 1400 abdomen becoming distended and firm on side with PEG tube.

When you have a clogged PEG, any other suggestions on what to do, other than what I did?

Thanks!!!

They actually have a PEG declogger We use where I work. Works every time!

[shiccy]

They actually have a PEG declogger We use where I work. Works every time!

What's it made of? Dehydrated Coca Cola? hehe

[Bec717]

Checked in and MD actually cut about 2 1/2 inches off tubing- he still can't explain why we could get a brush through, place H20 to a certain point, see no residue, etc, could not aspirate but hey it worked and so far saved having to undergo surgery!

I was not there today, just called to check but let's hope he wrote some orders to flush q 8 vs the Kangaroo Pump flush!!

Thanks all!!

[frann]

I wouldn't really call a peg replacement surgery. its more of minor procedure.

very quick, very easy.

down in Interventional radiology the Doc/NP/PA

puts a small/thin wire down the peg tube

they deflate the balloon and pull the old yucky tube off and then they slip the new tube on

over the wire

this is not a emergency procedure, don't call us after 3pm thinking its going to be done today

[Bec717]

Thanks & glad to know our hospital runs 24/7 and has thus far been very accommodating to our patient's needs, no matter how big or small.

A PICC RN was great about coming to the unit at 5pm on a Friday for a difficult IV stick and even offered to stay and place a PICC fi MD okay'd & family consented which ended up being a start to finish 2 hr vs 30 minutes due to MD call, family call, etc and then to some small complications at bedside! She rocks!!

[Esme12, ASN, BSN, RN]

What's it made of? Dehydrated Coca Cola? hehe

NO.....MEAT TENDERIZER.....