What is the proper procedure for feeding through a Percutaneous Endoscopic Gastrostomy (PEG) tube?

From the Guidelines

The proper procedure for feeding through a Percutaneous Endoscopic Gastrostomy (PEG) tube involves several key steps to ensure safety and effectiveness, including washing hands, positioning the patient upright, checking tube placement, flushing the tube, and feeding through the tube with a syringe, as recommended by the most recent guidelines 1.

Key Steps for Feeding through a PEG Tube

• Wash hands thoroughly and gather necessary supplies, including the prescribed formula, a 60 mL syringe, water for flushing, and clean gloves.
• Position the patient in an upright position (at least 30-45 degrees) to reduce the risk of aspiration.
• Check the tube placement by aspirating gastric contents and measuring pH (should be 1-5.5) or following the healthcare provider's recommended verification method.
• Flush the tube with 30 mL of water before feeding.
• For the actual feeding, remove the cap from the PEG tube, attach the syringe without the plunger, and pour the room-temperature formula into the syringe, allowing it to flow by gravity.
• Control the flow rate by adjusting the height of the syringe.
• After feeding, flush the tube with 30-60 mL of water to prevent clogging.
• Close the tube cap securely.
• Keep the patient upright for 30-60 minutes after feeding to prevent reflux and aspiration.

Regular Tube Maintenance

• Daily cleaning of the insertion site with mild soap and water.
• Rotating the external disc slightly.
• Checking for signs of infection or leakage. This procedure helps maintain proper nutrition while preventing complications such as tube blockage, infection, or aspiration pneumonia, as supported by the ESPEN guidelines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG) 1.

From the Research

Proper Procedure for Feeding through a PEG Tube

To feed through a Percutaneous Endoscopic Gastrostomy (PEG) tube, the following steps should be taken:

• Ensure the PEG tube is properly placed and secured to prevent complications such as bleeding, site infection, tube migration, and inadvertent creation of fistula 2.
• Use a non-touch technique when administering enteral feed via PEG to reduce the risk of bacterial contamination 3.
• Follow a strict procedure protocol to minimize the risk of complications, such as minor and major complications that can occur in 13% and 8% of patients, respectively 4.
• Monitor the patient for signs of complications, such as abdominal tenderness, guarding, or rigidity, and report any concerns to a healthcare professional 5.

Key Considerations

• PEG feeding is a common form of enteral feeding for patients requiring artificial nutritional support for longer than 4-6 weeks 6.
• Nurses should have the knowledge and skills required to administer enteral feeding via PEG safely and effectively, and work within their level of competence 3.
• Enteral nutrition via PEG aims to meet the nutritional requirements of patients with an intact gastrointestinal tract but inadequate oral intake 3.
• Management of the PEG feeding tube and care of the stoma site are vital to prevent complications and ensure patient safety 3.

Administration of PEG Feed

• Enteral feed can be administered via PEG tube after the tube has been properly placed and secured 3.
• Feeding can be resumed after a certain period, such as 48 hours, depending on the patient's condition and the healthcare provider's instructions 2.
• Patients should be monitored for tolerance to the feed and any signs of complications, and the feed should be adjusted as needed 5.