PEG Tube to suction..

[RN2114]

I need some advice. I recently had a patient with an ileus. The patient was extremely confused and had a peg tube. When I informed to doctor of the KUB results, he ordered and NGT. Another nurse on the unit said you can use the PEG tube for suction. I personally did not feel comfortable obtaining the order so the other nurse did. I consulted and ER nurse and an internal medicine MD for advice. Both advised me the above was not reccommended. I feel that the bowel and gastric mucosa can become damanged and/or damage the peg. I need some advice! Please help!

[KarmaComesAround]

I have not been a nurse for a long, long time, but the years I have been a med/surg nurse, I have never had an order for a PEG to suction, and I have had a good many PEG tube patients. NGT or Dobhoff-yes.

And, a lot of the time it was only to intermittent suction. I had a surgeon explain to me that he preferred low intermittent suction because stuff can stick to the suction tubing, and the suction stopping for a bit lets it get lose, and then it gets suctioned on out. Also, easier on stomach mucosa.

Anyway, I am sure there are many other nurses, ICU nurse experts, and nurses with more experience that have better advice. This is just my experience thus far.

[himilayaneyes]

I personally have seen PEG tubes to suction...but few and far between. It's not something that's done on a regular basis. At the end of the day, you have to follow the MD's orders. If you don't feel comfortable, ask the GI doc on the case unless it was GI who ordered it....more than likely the attending doc isn't going to go against GI. And sticking a NGT or Dobhoff in can damage the mucosa...it's a foreign body...follow the orders. If there's an order, then your butt is covered. You can also politely ask the doc the rationale behind suctioning through the PEG vs. a NGT.

[Reno1978, BSN, RN]

I've had PEG tubes ordered to gravity drainage, but never to suction.

[NeoPediRN]

I work in peds and we only put the GTs to gravity, never to suction, for exactly the reason you stated.

[Spritenurse1210, BSN, RN]

I've seen a Peg tube attached to low wall intermittent suction before. The patient had something perfed, and bowell contents were just pouring out of his wounds. The peg to suction was a last-ditch effort in order to controll the leaks. The patient also had a Moss tube as well. I suppose they use it in severe cases only. I've only seen it once though.

[dura_mater]

At the end of the day, you have to follow the MD's orders.

...follow the orders. If there's an order, then your butt is covered.

I beg to differ with this rationale, this type of thinking can get nurses in a lot of trouble.

Even if there is an order, it doesn't mean we should just blindly follow it. I believe the standard that we are held to is what another reasonable, prudent nurse would do given the same situation. Doctors are not above making mistakes, and we, as nurses, need to be able to use our critical thinking skills to question orders that just don't seem right.

On the topic of peg tubes to suction, I can't say that I have seen this being done.

[K+MgSO4, BSN]

How did they get a diagnosis from a Kidneys, Ureters and Bladder X ray and not a AXR?

Also never seen a peg to suction. Gravity yes with orders for in the bed or hanging lower on the cot sides. With or without 4 hourly aspirates.

[MassED, BSN, RN]

I personally have seen PEG tubes to suction...but few and far between. It's not something that's done on a regular basis. At the end of the day, you have to follow the MD's orders. If you don't feel comfortable, ask the GI doc on the case unless it was GI who ordered it....more than likely the attending doc isn't going to go against GI. And sticking a NGT or Dobhoff in can damage the mucosa...it's a foreign body...follow the orders. If there's an order, then your butt is covered. You can also politely ask the doc the rationale behind suctioning through the PEG vs. a NGT.

I haven't heard of it, but it does make sense if there's an obstruction (or want bowel rests) that you can suction via the PEG to clear gastric contents.... it makes sense.

[MassED, BSN, RN]

i've seen a peg tube attached to low wall intermittent suction before. the patient had something perfed, and bowell contents were just pouring out of his wounds. the peg to suction was a last-ditch effort in order to controll the leaks. the patient also had a moss tube as well. i suppose they use it in severe cases only. i've only seen it once though.

what's a moss tube?

[ErinS, BSN, RN]

I work in hospice, so it is a little different, but we often have peg tubes placed specifically for stomach draining r/t obstruction (usually from CA). We usually use suction, but usually intermittently. I have not seen any issues with this, and it is certainly kinder than a long term ng tube. Again, i realize that this is a different situation.

[Mike A. Fungin RN]

I've seen PEG to suction ordered on rare occasions, usually in patients with extensive abdominal trauma.