peg tube placement

CT Pixie, BSN, RN · Nov 17, 2007

Can only answer with my experience of a student.

The most accurate way to know if the tube is still in the correct placement is an XRay, without the benefit of an XRay in certain situations like in a LTC facility, We are to inject air into the tube at each flush and with each med administration.

The tube is orignially placed in the stomach but that doesn't ensure that its still in its correct placement. So we must check each time.

I guess the best answer to your question would be the policy/protcols of your facility.

Hope that helps.

morte, LPN, LVN · Nov 17, 2007

Can only answer with my experience of a student.
The most accurate way to know if the tube is still in the correct placement is an XRay, without the benefit of an XRay in certain situations like in a LTC facility, We are to inject air into the tube at each flush and with each med administration.
The tube is orignially placed in the stomach but that doesn't ensure that its still in its correct placement. So we must check each time.
I guess the best answer to your question would be the policy/protcols of your facility.
Hope that helps.

were is it going to go?

CT Pixie, BSN, RN · Nov 17, 2007

were is it going to go?

Out of the stomach.

morte, LPN, LVN · Nov 17, 2007

Out of the stomach.

i didnt ask were it was no longer, i asked were it was going to go.....were would it be, if not in the stomach?

Thunderwolf, MSN, RN · Nov 17, 2007

Yes, to auscultate an air rush...and also to eval if return of gastric contents upon withdrawal via piston syringe.

CT Pixie, BSN, RN · Nov 17, 2007

i didnt ask were it was no longer, i asked were it was going to go.....were would it be, if not in the stomach?

I answered where it would be if it were not in the stomach any longer...

If its not IN the stomach, then its placement would be somewhere out of the stomach. I couldn't tell you exactly where each dislodged PEG tube is going to go.

Just like if a foley catheter dislodges, it was IN the bladder..then its OUT of the bladder.

morte, LPN, LVN · Nov 17, 2007

I answered where it would be if it were not in the stomach any longer...
If its not IN the stomach, then its placement would be somewhere out of the stomach. I couldn't tell you exactly where each dislodged PEG tube is going to go.
Just like if a foley catheter dislodges, it was IN the bladder..then its OUT of the bladder.

i was trying to get you to use your critical thinking skills. were could it possible go, and especially, were could it go, that auscaltating would do ANY GOOD? if it migrates into the small intestine, you will still hear the air....and likely the tube will be sucked in.....about the only other thing that could happen would be to come out of stomach, but not out thru the skin/subcutaneous tissue and be in the peritoneal cavity...guess what, still going to hear that air.....good luck

CT Pixie, BSN, RN · Nov 17, 2007

i was trying to get you to use your critical thinking skills. were could it possible go, and especially, were could it go, that auscaltating would do ANY GOOD? if it migrates into the small intestine, you will still hear the air....and likely the tube will be sucked in.....about the only other thing that could happen would be to come out of stomach, but not out thru the skin/subcutaneous tissue and be in the peritoneal cavity...guess what, still going to hear that air.....good luck

sorry Morte, I thought you were trying to say that it couldn't come out of the stomach. I do know that it can migrate into the small intestine or into the peritoneal cavity. Had you phrased the question differently I might have caught onto you trying to get me to think critically and tell you where the tube might possibly go. It just seemed that you were asking me where exactly the tube might go.

and yes, we were told that you could still possible hear the "whoosh" of air even if the tube is no longer located directly in the stomach. But in the LTC setting, injecting air is pretty much the only way they check placement in the facilities I've been at.

But thank you for trying to make me get my critical thinking skills going. I was online trying to get all the specific locations that it could go but had to leave before I could post all the specific places.

Nrs_angie, BSN, RN · Nov 18, 2007

wow this thread seemed to get carried away...

what I think the other posters were trying to say is that after initial placement the most reliable way to check placement is Xray... but after that typically nurses do always check placement by instilling air and listening for the gurgling noise, however it should be noted that this method is not always accurate... a more reliable way is to aspirate gastric contents and observe the color/characteristic and test it with pH paper... the pH will indicate if it migrated into the intestine, or the lung, or if it is still in the stomach... also the color and character of the aspirate will differ from gastric secrections if the tube has migrated to the tracheobronchial tree or the duodenum (pH will be different in each area)

morte, LPN, LVN · Nov 18, 2007

wow this thread seemed to get carried away...
what I think the other posters were trying to say is that after initial placement the most reliable way to check placement is Xray... but after that typically nurses do always check placement by instilling air and listening for the gurgling noise, however it should be noted that this method is not always accurate... a more reliable way is to aspirate gastric contents and observe the color/characteristic and test it with pH paper... the pH will indicate if it migrated into the intestine, or the lung, or if it is still in the stomach... also the color and character of the aspirate will differ from gastric secrections if the tube has migrated to the tracheobronchial tree or the duodenum (pH will be different in each area)

a peg isnt going to migrate to a lung....

Nrs_angie, BSN, RN · Nov 18, 2007

a peg isnt going to migrate to a lung....

then IGNATAVICIUS & WORKMAN owe me about $92 bucks!