From the Guidelines
For patients with End-Stage Renal Disease (ESRD) who have a Percutaneous Endoscopic Gastrostomy (PEG) tube, the recommended flushing protocol is to use about 40 ml of drinking or still mineral water after feed or medication administration, as stated in the ESPEN guidelines on artificial enteral nutrition 1. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of routine water flushing to prevent tube obstruction 1.
Key Considerations
- The flushing protocol should be part of patient/carer education to ensure proper care of the PEG tube.
- The use of drinking or still mineral water is recommended for flushing, as it is gentle on the stomach and less likely to cause discomfort.
- The volume of water used for flushing should be carefully managed in ESRD patients to prevent fluid overload, which can lead to complications such as pulmonary edema or hypertension.
- Accurate fluid intake records, including all PEG tube flushes, should be maintained to ensure the patient stays within their prescribed daily fluid allowance.
Flushing Protocol
- Flush the PEG tube with about 40 ml of drinking or still mineral water after each feed or medication administration.
- Use room temperature water to minimize discomfort.
- Flush slowly over 30-60 seconds to prevent cramping or discomfort.
- Between medication administrations, flush with at least 15 mL of water to prevent drug interactions. By following this flushing protocol, patients with ESRD who have a PEG tube can minimize the risk of tube obstruction and maintain proper hydration while respecting their fluid restrictions, ultimately improving their quality of life and reducing morbidity and mortality risks.
From the Research
Flushing Protocol for PEG Tube in ESRD Patient
- The recommended flushing protocol for a Percutaneous Endoscopic Gastrostomy (PEG) tube is not explicitly stated in the context of End-Stage Renal Disease (ESRD) patients.
- However, according to the study 2, the PEG tube was flushed with 60 mL of sterile water after the examination, as part of the protocol to initiate enteral nutrition 4 hours after the PEG tube insertion.
General Care and Maintenance of PEG Tube
- Regular flushing of the PEG tube is essential to prevent clogging and maintain patency 3.
- The European Society of Gastrointestinal Endoscopy (ESGE) recommends daily tube mobilization and a loose position of the external PEG bumper to mitigate the risk of buried bumper syndrome 4.
Infection Prevention and Management
- Antibiotic prophylaxis is recommended to reduce the risk of peristomal wound infection associated with PEG insertion 5, 6.
- The ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic to decrease the risk of post-procedural wound infection 4.