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peg tube placement

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hello! since the peg is already in the stomach, do we still need to check for the placement by infusing air?:uhoh3:

CT Pixie, BSN, RN

Has 10 years experience.

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.

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

Has 10 years experience.

were is it going to go?

Out of the stomach.

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

Specializes in Med-Surg, Geriatric, Behavioral Health. Has 32 years experience.

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

CT Pixie, BSN, RN

Has 10 years experience.

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.

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

Has 10 years experience.

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

Specializes in Med-Surg, Tele, Vascular, Plastics. Has 2 years experience.

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)

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

Specializes in Med-Surg, Tele, Vascular, Plastics. Has 2 years experience.

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

then IGNATAVICIUS & WORKMAN owe me about $92 bucks!

then IGNATAVICIUS & WORKMAN owe me about $92 bucks!

whomsoever they may be, use your critical thinking, how would a peg tube migrate into a lung?

CT Pixie, BSN, RN

Has 10 years experience.

I think Nrs_Angie is speaking of

Medical-Surgical Nursing, 5th Edition - Critical Thinking for Collaborative Care, Single Volume

By Donna D. Ignatavicius, MS, RN, Cm and M. Linda Workman, PhD, RN, FAAN

that still begs the question, how would a PEG migrate to a lung?

Nrs_angie, BSN, RN

Specializes in Med-Surg, Tele, Vascular, Plastics. Has 2 years experience.

that still begs the question, how would a PEG migrate to a lung?

perhaps it could have punctured the tracheobronchial tree during placement

if I am wrong...sue me... but I will write a letter to the experts who wrote the book if it will make you feel better

and if morte can PROVE that an ET or PEG tube can't go into a lung... then provide the source where you researched this... just prove to me that it could never happen and I will throw this $92 book in the dumpster

additionally if Morte had such great critical thinking skills then he would know that HIGHEST concern of the RN should be SAFETY... we are required by law to practice SAFELY and COMPETANTLY... if there is the slightest chance... I dont care if its a 0.0009% chance... that the tube could be in the lung... it is OUR job to assess for placement!

Happy Holidays!

P.S. I also want my 50,000 grand back from tuition money at the school, where my Instructor had stated that there is a danger the tube could be in a lung.

Nrs_angie, BSN, RN

Specializes in Med-Surg, Tele, Vascular, Plastics. Has 2 years experience.

I think Nrs_Angie is speaking of

Medical-Surgical Nursing, 5th Edition - Critical Thinking for Collaborative Care, Single Volume

By Donna D. Ignatavicius, MS, RN, Cm and M. Linda Workman, PhD, RN, FAAN

BINGO! Paid $92 bucks for it. Thanks CTpixie

btw for those of you who have the book, you can refer to page 1370, under the heading Complications of Total Enteral Nutrition

BINGO! Paid $92 bucks for it. Thanks CTpixie

btw for those of you who have the book, you can refer to page 1370, under the heading Complications of Total Enteral Nutrition

the only time it could be in a lung would be on placement which is a moot point to the nurse on the floor....as placement would have been ascertained by xray before use.....since i have never worked in endo, dont even know if it is possible to have it happen then......use your critical thinking skills, how is a soft latex tube going to go from the stomach...to a lung?it isnt long enough to go up the esophagus and back down.....and isnt going to puncture the stomach, the diaphragm and a lung.

please feel free to write to those authors, i would be interested to see their explanation.

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