PEG Care Recommendations for Caregivers
Caregivers of individuals with PEG tubes should perform daily site monitoring, proper cleaning, appropriate dressing changes, and tube maintenance to prevent complications and ensure optimal nutrition delivery. 1, 2
Daily Site Care and Monitoring
For Newly Placed PEG (First 7-10 Days)
- Monitor the site daily for signs of:
- Bleeding
- Pain
- Erythema (redness)
- Induration (hardening)
- Leakage
- Inflammation 2
- Clean the site daily with:
- 0.9% sodium chloride
- Sterile water
- Freshly boiled and cooled water 2
- Apply a sterile Y-dressing under the external disc plate 2
- Ensure proper tension between internal and external bolsters (avoid excessive pressure) 1
For Established PEG Sites (After Initial Healing)
- Reduce dressing changes to once or twice weekly 2
- Clean with soap and water of drinking quality 1, 2
- Allow showering after initial wound healing (1-2 weeks after insertion) 1
- Remove dressings before washing, rinse away residual soap, and dry the tube well before applying a new dressing 1
Tube Positioning and Maintenance
- Allow 0.5-1 cm free movement between the skin and external bolster 2
- Rotate the tube daily and move it inward at least once weekly (2-3 cm) to prevent buried bumper syndrome 1, 2
- Push the tube approximately 2-3 cm ventrally and carefully pull back to the resistance of the internal fixation flange during dressing changes 1
- Flush the tube with 30-40 ml of water before and after each feeding and medication administration 1, 2
- Check balloon volume weekly if using a balloon-type tube (inflate with sterile water, not saline) 1
Complication Management
Infection Management
- If infection is suspected, obtain a swab for microbiological examination 1
- Apply topical antimicrobial agent to the entry site and surrounding tissue 1, 2
- Consider systemic broad-spectrum antibiotics for persistent infections 1
Excessive Granulation Tissue
- Common complication that should be treated promptly 1
- Treatment options include:
- Topical antimicrobial agent under the fixation device
- Foam or silver dressing over the affected area
- Cauterization with silver nitrate
- Topical corticosteroid cream or ointment for 7-10 days 1
Leakage Management
- Apply a barrier film or cream to protect surrounding skin 1
- Consider hydrocolloid wafer as a keyhole dressing 1
- Apply a topical skin product containing zinc oxide 2
Tube Blockage Prevention
- Flush tube with 40 ml of water after each feed or medication administration 1
- For established blockage, tube replacement may be necessary 1
Common Pitfalls to Avoid
- Applying excessive traction to freshly inserted PEG tubes 2
- Using occlusive dressings that promote moisture and lead to skin maceration 2
- Placing dressings under the exterior bumper with excessive tension 2
- Neglecting daily rotation and weekly inward movement of established tubes 2
- Failing to recognize buried bumper syndrome, which requires prompt intervention 2
- Using carbonated drinks or acidic juices to unclog tubes 2
Caregiver Education and Support
- Provide training on:
- Proper tube care and feeding techniques
- Recognition of complications
- When to seek medical attention 1
- Organize further aftercare and nutritional supply 1
- Provide social support for patient and family 1
- Develop an individual nutrition plan (calculating daily calorie and fluid requirements) 1
By following these evidence-based recommendations, caregivers can help prevent complications, ensure proper nutrition delivery, and improve quality of life for individuals with PEG tubes.