For those with difficulty swallowing or unable to consume food orally, a percutaneous endoscopic gastrostomy (PEG) tube may be surgically placed by creating a small hole in the stomach and inserting the PEG tube. Once the tube is in the correct position, liquid nutrition can be administered through the tube, directly into the stomach. PEG tubes may be placed temporarily or permanently, and provide total nutrition or to supplement oral intake.
A PEG tube is typically not cleared for use for 24-48 hours after the placement surgery. Correct placement of the tube must be confirmed and the stomach must have time to recover from the procedure. A doctor will give instructions on appropriate liquid nutrition, as well as determine how the supplement will be delivered--either by pump, gravity bag or syringe. For those using the electronic pump, it is advisable to learn a manual way to deliver the supplement, such as by gravity bag or syringe, in case of pump malfunction.
Once the method of delivery is established, gather the appropriate supplies. If a feeding pump is to be utilized, secure a pump that is functioning and has all the necessary components. Confirm the correct supplement and the correct dose prior to starting the feeding. The doctor and nutritionist will work together to determine which nutrient supplementation would be best for the given situation. No changes should be made without consulting either of these medical professionals.
Gather the following supplies: 30-60 milliliter needle nose syringe, feeding bag and clean water. The feeding bag should be checked for compatibility if using a feeding pump. An IV pole or a hook to hang the bag from, will be necessary. Having a towel on hand is advisable in case of tube seepage or spills.
Administering the Tube Feeding
Cleanliness is the most important step to administering PEG tube feedings. The abdominal opening through which the PEG tube enters the stomach and the tube, itself, are possible entry points for bacteria, so there is a constant risk for infection. The storage area and supplies need not be sterile, but be kept clean to lower the risk of infection. The most important component of cleanliness is a good handwashing technique. This drastically reduces the risk of infection.
Prime the line, or tubing, of the feeding bag. This means to pour the supplement into the feeding bag and let it flow through to the end of the delivery tube to remove the air from the feeding bag tube. This measure prevents air being pumped into the stomach and causing discomfort. Once the tube is primed, clamp it, and place a cap on the end until it is attached to the PEG tube.
Position the person receiving the tube in as upright a position as tolerated. This prevents aspiration should there be any reflux. Prior to starting the feeding, approximately 30 ml of clean water should be drawn into the syringe. Open the cap on the PEG tube and the water from the syringe should be administered slowly. This step clears the PEG tube and helps determine if there is any blockage that may hinder the delivery of the nutritional supplement. If the water can be instilled easily, then the line of the feeding bag should be attached to the PEG tube.
Once the feeding is complete, use 30-60 ml of water to flush any remaining supplement from the PEG tube. Replace the cap on the PEG tube and allow the recipient to remain upright for at least 30 minutes.
Never force fluid through a PEG tube that appears to be clogged. This can cause serious harm. The liquid supplemental nutrition is a prime medium for bacteria; do not use cans that have been opened for an extended, or unknown, amount of time. When administering the feeding, pay attention to the PEG tube site. Discoloration at the site, leakage around the insertion site or displacement of the tube should be reported immediately.