PEG tube placement checks

[IngyRN]

Hi All,

At my hospital, RN's check placement of PEG by inserting 30cc of air and listening w/stethoscope. Is this common practice?

I thought this technique was done to check placement of NGT since it could dislodge. I was under the impression that PEG tube placement was checked by aspirating stomach contents and checking pH.

Can anyone offer any insight? Thanks!

[jbpresley]

I just had a conversation about this issue with a nurse I am working with in practicum. She disagreed with me about the importance of checking placement on peg tubes so we asked several nurses on the floor. Half of the nurses said they did and half did not. Here is my issue with not checking placement. Although the peg is sutured in and surgically placed my a doc and the chances of it being dislodged are rare, it can happen and when it does, bad news bears! We had an issue with a patient several years ago in which the primary nurse did not check placement on a peg prior to admin meds and feedings, the nursing students caring for the patient along with their instructor attempted to verify placement and could not, also they were unable to aspirate contents. They informed the primary nurse of this and she decided to go ahead with the feeding and admin of the meds. The pt became septic and died because all of the feedings and medications were going into the peritoneal cavity instead of the stomach. One would think that if the feedings and what not were not going where they should the abdomen would be distended and tender but the abd was not distended, it was soft and the pt did not complain of tenderness. I know this is rare but what is the harm in checking placement, it is one more step in the process but it only takes a second and it is worth it in my opinion. For the saftey of the patient and to CYA, just take the time and do it correctly.

[XingtheBBB, BSN, RN]

Ever seen a PEG migrate into the peritoneum? THAT's scary stuff. Sepsis, washouts, etc. I check. Even buttons. Just vent or aspirate, assess contents, and auscultate. I don't know if the nurses were checking that peritoneal "G" tube or what they saw and hear when they did. But if I were them, I'd want to stand in court (Oh yes, there may be court) and say I did every prudent thing.

[morte, LPN, LVN]

Ever seen a PEG migrate into the peritoneum? THAT's scary stuff. Sepsis, washouts, etc. I check. Even buttons. Just vent or aspirate, assess contents, and auscultate. I don't know if the nurses were checking that peritoneal "G" tube or what they saw and hear when they did. But if I were them, I'd want to stand in court (Oh yes, there may be court) and say I did every prudent thing.

a G tube can not migrate into the peritoneum. The stomache would have to be perf'ed. in which case auscaltation will do no good.....checking for pH may also do no good depending if the tube actually has gone out the perf, or is still in stomache, and the contents are seeping out into the peritoneum.

i would wonder if either of these two were actually J tubes?

[XingtheBBB, BSN, RN]

Well, actually they can. In this case the PEG was fairly recent and the tract had not matured. Tracts can also erode. I'm not sure if the migration started with balloon failure or erosion of stomach mucosa.

I know the difference between a PEG and a PEJ, thank-you.

[jrsmrs]

I'm only a student but in one of my recent clinicals I got to change a PEG tube. My instructor walked me through it, and after putting the new tube in, I just aspirated the contents to make sure it looked like the formula the woman was on, and that was it.

[celticgirl]

I was taught in nursing school to check residual with a peg (aspirate), 30cc of air with an NG and Xray with a dob-hoff.