How to set up a Kangaroo Omni device for a PEG (Percutaneous Endoscopic Gastrostomy) tube?

Setting Up a Kangaroo Omni Device for PEG Tube Feeding

The Kangaroo Omni device should be set up with proper positioning, appropriate flow rate settings, and regular water flushes to ensure optimal nutrition delivery through a PEG tube while minimizing complications like tube clogging and aspiration.

Initial Setup and Positioning

1. Patient Positioning

   • Position the patient with head elevated at minimum 30° angle during and for 30 minutes after feeding to reduce reflux and aspiration risk 1
   • Ensure the PEG tube site is visible and accessible

2. Equipment Preparation

   • Place the Kangaroo Omni pump on a stable IV pole at appropriate height
   • Ensure the device is plugged into a power outlet when possible
   • Clean hands thoroughly before handling equipment
   • Check that the PEG tube is properly positioned and functioning before connecting

Feeding Administration Setup

1. Formula Preparation

   • Use room temperature formula (cold formula can cause cramping)
   • Shake formula container well before opening
   • Check expiration date and formula integrity

2. Feeding Set Assembly

   • Open a new Kangaroo feeding set appropriate for the Omni pump
   • Close all clamps on the feeding set
   • Insert the feeding set spike into the formula container
   • Hang the formula container on the IV pole
   • Fill the drip chamber to the fill line
   • Prime the tubing by opening the clamps and allowing formula to flow through, removing all air bubbles
   • Load the feeding set into the Kangaroo Omni pump according to the directional arrows on the pump

3. Pump Programming

   • Turn on the Kangaroo Omni pump
   • Set the prescribed flow rate (typically 50-120 mL/hr for continuous feeds)
   • Set volume to be delivered if using a specific volume
   • Program flush intervals and volumes (minimum 30 mL water before and after each feeding and after medication administration) 1
   • Confirm all settings before starting the pump

4. Connecting to PEG Tube

   • Flush the PEG tube with 30 mL of water before connecting 1
   • Connect the feeding set to the PEG tube securely
   • Start the pump

Monitoring and Maintenance

1. Regular Monitoring

   • Check patient positioning regularly to maintain elevation
   • Monitor for signs of aspiration (coughing during feeding, respiratory distress)
   • Check the PEG site daily for signs of infection (redness, swelling, discharge) 1
   • Monitor fluid status, electrolytes, and weight regularly 1

2. Tube Maintenance

   • Flush the tube with at least 30 mL of water before and after each feeding 1
   • Flush after medication administration to prevent clogging 1
   • For continuous feeding, pause the pump and flush the tube with water every 4-6 hours

3. Site Care

   • Clean the PEG site daily with mild soap and water
   • Allow approximately 1 cm of play between skin and external bolster to prevent buried bumper syndrome 1
   • Keep the site dry and exposed to air when possible

Troubleshooting Common Issues

1. Pump Alarms

   • No Flow/Occlusion: Check for kinks in the tubing, flush the PEG tube, check formula viscosity
   • Air in Line: Reprime the tubing, check connections for leaks
   • Low Battery: Connect to power outlet
   • Feed Error: Check formula container is not empty, feeding set is properly loaded

2. PEG Tube Issues

   • Clogging: Flush with warm water, avoid using excessive force
   • Leakage around site: Check external bolster position, assess for infection
   • Dislodgement: Cover site with sterile dressing and seek immediate medical attention

Special Considerations

1. Medication Administration

   • Use liquid medications when possible 1
   • Crush tablets finely and dissolve completely in water
   • Never add medications directly to formula
   • Administer each medication separately with water flushes between
   • Avoid hyperosmolar drugs, potassium supplements, iron supplements, and sucralfate as they are more likely to cause clogs 1

2. Preventing Complications

   • For patients with recurrent aspiration, consider conversion to gastrojejunostomy tube 1
   • Monitor for signs of refeeding syndrome in malnourished patients 1
   • Schedule nebulizer treatments away from feeding times to reduce aspiration risk 1

By following these guidelines for setting up and managing the Kangaroo Omni device for PEG tube feeding, you can help ensure safe and effective enteral nutrition delivery while minimizing complications.