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Discussion

PEG tubes

Could someone walk me through the protocol/process for checking peg tube placement and subsequently administering meds through the tube? I did this once in Nursing 1, but it's been a while and now I can't remember the exact order/details! Help! Thanks! :nuke:

Featured Replies

to check for placement- inject 30 cc of air into peg while auscaltating the abdomen

check for residuals

mix crushed meds with 30 cc of fluid

draw up

push through peg

flush with 30 cc of fluid

hope this helps

  • Experts

copy and print out these instructions so you don't lose them!

from page 336-7 of nurse's 5-minute clinical consult: procedures:

  • equipment
    • 50/60 ml catheter tip piston syringe
    • 4x4 gauge pad
    • gloves
    • 50 ml of water
    • juice, water or nutritional supplement for dilution the drug
    • spoon and cup to mix for mixing
    • drug crusher

    [*]wash your hands

    [*]verify the order

    [*]check the label on the drug 3 times before preparing it for instillation

    [*]request liquid forms of the drugs, if available. if the prescribed drug is in tablet form, crush the tablets.

    [*]bring the drug and equipment to the patient's bedside

    [*]confirm the patient's identity

    [*]inform the patient what you are going to do and provide privacy

    [*]cover the chest or abdomen with a towel or linen saver pad to protect him and the bed from spills

    [*]assess his abdomen for bowel sounds and distension

    [*]elevate the bed to semi-fowler's or high-fowler's position to prevent aspiration of gastric contents by gastroesophageal reflux, and to promote digestion

    [*]put on the gloves

    [*]check the patency of the tube and its position by uncapping or unplugging it and attaching the syringe

    [*]gently aspirate stomach secretions - they will have the appearance of any tube feeding the patient is receiving at the time, or if no tube feeding is being given, aspirate may be grassy green, clear and colorless with mucus shreds or brown

    [*]after establishing patency, clamp the tube, detach the syringe and lay the end of the tube on a 4x4 gauze pad.

    • mix the crushed tablets or liquid drug with juice, water or a nutritional supplement to dilute the drug
    • for capsules, open them and empty their contents into the diluting liquid
    • pour liquid drugs directly into the diluting liquid.
    • stir well with a spoon. make sure particles were crushed small enough and are dissolved small enough to pass through the eye at the distal end of the tube

    [*]reattach the syringe, without the piston, to the end of the tube

    • hold the syringe and tube above the stomach and pour the diluted drug into the barrel of the syringe
    • open the clamp so the medication mixture may begin flowing into the tube
    • to prevent air from entering the stomach hold the syringe at a slight angle and add more drug before the syringe empties
    • if necessary, raise the tube slightly higher to increase the flow rate
    • if its too thick, dilute it with water
    • administer until the entire dose has been given
    • as the last of the drug flows out of the syringe, irrigate the tube by adding 30 to 50 ml of water.

    [*]when the water stops flowing, quickly clamp the tube and detach the syringe

    [*]properly discard the syringe

    [*]recap the tube.

    [*]remove the towel or linen-saver.

    [*]leave the patient in fowler's position for 30 minutes.

    [*]documentation

    • record the date and time
    • record the dose
    • note the patient's tolerance of the procedure
    • record the amount of fluid instilled on the i&o sheet

  • Gather your supplies:

    • meds
    • stethoscope
    • plastic cups (at least 2)
    • syringe with plunger (should be in patient's room)
    • hemostat (not necessarily needed, but helps!)
    • clean towel
    • clean gloves
    • graduated cylinder (if aspirating stomach contents)

  • Be sure the HOB is elevated at least 30 degrees.
  • Place towel on patient to avoid getting them wet with PEG tube contents, accidentally splashing them with water, etc.
  • If your patient is receiving a continuous infusion of something, turn the machine off.
  • Clasp tube with hemostat or pinch if you don't have one
  • I have heard variations in the amount of air to be injected. One of my instructors said to inject 30-50cc air while my clinical instructor said to inject 20cc. I do 20cc.
  • Disconnect the tube running from the machine from the PEG tube and hang it on the machine. Insert the syringe tightly into the PEG tube opening (where the machine tube was connected)
  • Using your stethoscope, place it on the abdomen next to the tube
    • Listen for BS
    • Should be above the stomach

    [*]Unclamp the tube the inject air into the tube to hear a "gurgle" (this ensures that the tube is still in the stomach)

    [*]Clasp with the hemostat or pinch the tube shut.

I had a patient this semester with a PEG tube. She was also in a coma and was receiving a continuous infusion of DiabetaSource. My instructor said that because of this, I did not have to aspirate for stomach contents.

  • Remove syringe from tube and remove the plunger, then reconnect the tube.
  • I like to flush the tube with some water (roughly 1/2 plastic cup) before administering meds. Make sure the water is warm - if you administer cold water this can cause GI upset. Unclamp the tube, pour some water into the syringe (w/o the plunger in it) and let the water flow through the tube by gravity. Reclamp the tube.
  • Meds need to be crushed before they can be administered through a PEG tube. Always check to make sure that the drugs you are administering are safe to be crushed! After crushing, mix them in ~30cc of warm water.
  • Unclamp the tube.
  • Pour medicine/water mix into the syringe and let it flow down by gravity.
  • Add some water to the original cup that had the medicine/water mix to get the "residue" to make sure the patient is getting the right dose of medication. Add to the syringe.
  • Flush tube with water.
  • Clasp tube shut.
  • Disconnect syringe.
  • Recap tube or reconnect tube to continuous infusion if patient is on that.
  • Remove towel.
  • Clean out syringe and plunger with water, dry and place it back in its bag. Place bag by the feeding machine.
  • Leave patient in the semi-fowler's position.
  • If patient is on a continuous infusion, be sure to the turn the machine back on (unless stated otherwise, for example drugs to be taken on an empty stomach, etc)
  • Assess for patient comfort. Document procedure.
    • Date, time
    • how much water was flushed through the tube
    • note if there were any blockages in the tube, etc.
    • patient's reaction to the procedure/how it was tolerated
    • sign & initial

1) check placement always and make sure the head of the bed is no lower than 30 degrees

2) check for residual 150cc or more call Doctor and with hold for at least one to two hours

3) waht ever you take out put back in.

4) use 60cc syringe to do a bolus and make sure that the knob is turned off to the patient, (dont want it fly up at you if they cough)

5) add formula keeping the syringe full until perscribed amount, then flush with 30 to 60 ml of water. (make sure you open tube back up)

same for Medications, measure and add, document and sign,

If they are on continuous its basically the same except calculate flow rate if not on orders and check every 4 hours for continuous gastrostomy tube feeding. Asses Pt every hour for tolerance while awake, flush to clear tube with 1 to 2 OZ. I hope this helps if not sorry. I just learned this myself, I know if they are on limited fluids you have to divide the fluids up between flushing and meds. :lol2:

Don't forget to include the fluids that you give as part of intake!! So for example if you give 30mL of fluid with the meds, include that on the I/O sheet.

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