What are the care orders for a Percutaneous Endoscopic Gastrostomy (PEG) tube?

From the Guidelines

Proper care for a Percutaneous Endoscopic Gastrostomy (PEG) tube involves daily cleaning of the insertion site, rotation of the tube, and flushing with water before and after feedings or medication administration, as outlined in the ESPEN guidelines 1. To ensure optimal care and prevent complications, the following steps should be taken:

• Clean the insertion site daily with mild soap and water, followed by thorough drying 1.
• Rotate the tube 360 degrees daily to prevent tissue adhesion 1.
• Check for signs of infection like redness, swelling, or discharge, and perform local disinfection if necessary 1.
• Flush the tube with 30-60 ml of water before and after each feeding or medication administration to prevent clogging 1.
• For medication administration, use liquid forms when possible or crush tablets finely and dissolve completely in water, never adding medications directly to formula 1.
• Maintain proper positioning with the head elevated 30-45 degrees during and for 30-60 minutes after feeding to prevent aspiration 1.
• Secure the tube to prevent tension or dislodgement, ensuring at least 5 mm of free movement 1.
• Check residual volumes before feedings by aspirating stomach contents; if greater than 100-150 ml, consider delaying feeding 1.
• Inspect the skin around the tube daily for breakdown and apply barrier cream if needed, replacing dressings only if soiled or wet 1. These practices help prevent complications like infection, tube obstruction, and skin breakdown while ensuring proper nutrition and medication delivery, as recommended by the ESPEN guidelines 1 and supported by the guidelines from the European and American Societies of Gastrointestinal Endoscopy 1.

From the Research

Care Orders for Percutaneous Endoscopic Gastrostomy (PEG) Tube

The care orders for a PEG tube involve several key aspects, including:

• Patient selection and preparation: adequate management of anticoagulation and antithrombotic agents, and prophylactic antibiotics to prevent bleeding and wound infection 2, 3
• Endoscopic insertion technique: proper technique to prevent complications such as wound infection, bleeding, and buried bumper syndrome 2, 3
• Complication management: early recognition and management of complications, including minor and major complications 2, 3
• Tube care and maintenance: regular cleaning and maintenance of the tube to prevent clogging and infection 4, 5
• Follow-up care: regular follow-up with a healthcare provider to monitor the patient's condition and adjust the care plan as needed 6, 5

Key Considerations

Some key considerations for PEG tube care include:

• The use of prophylactic antibiotics to prevent wound infection 2, 3
• The importance of proper tube placement and securement to prevent complications such as buried bumper syndrome and colocutaneous fistula 2, 3
• The need for regular dietetic assessment and follow-up to ensure the patient is receiving adequate nutrition 4, 5
• The importance of patient and caregiver education on PEG tube care and management to prevent complications and ensure optimal outcomes 5

Potential Complications

Potential complications of PEG tube placement and use include:

• Wound infection and bleeding 2, 3
• Buried bumper syndrome and colocutaneous fistula 2, 3
• Tube clogging and porosity 4
• Nausea, vomiting, and bloating 4
• Aspiration and pneumonia 4