Proper Procedure for Flushing a PEG Tube Using Kangaroo Omni Device
When flushing a PEG tube using a Kangaroo Omni device, administer at least 30 mL of water before, between, and after each medication or feeding to prevent tube occlusion. 1
Step-by-Step Flushing Procedure
Preparation
- Verify patient identity and check the PEG tube for proper placement
- Wash hands thoroughly and gather all necessary supplies
- Position the patient with head elevated at minimum 30° angle to reduce aspiration risk 2
Flushing Technique
- Initial flush: Administer 30 mL of water through the PEG tube before any medication or feeding
- Medication administration:
- Administer each medication individually (never mix medications)
- Flush with 30 mL of water between each medication
- After medication/feeding: Administer 30 mL of water as final flush
- Maintain patient position: Keep patient's head elevated for at least 30 minutes after feeding 2
Important Considerations
Medication Administration
- Medications should be given in liquid form when possible to reduce clogging risk 2
- Avoid hyperosmolar drugs, potassium supplements, iron supplements, and sucralfate as they are more likely to cause clogs 2
- Never shake syringes to remove medication as this can expose the environment to the drug and affect dosing 1
Tube Maintenance
- For balloon-type tubes, check water volume weekly and replace every 3-4 months due to balloon degradation 2
- Allow approximately 1 cm of play between skin and external bolster to prevent buried bumper syndrome 2
- Perform daily inspection of the tube insertion site for signs of infection or complications 2
Avoiding Common Pitfalls
Preventing Tube Occlusion
- Never mix medications before administration through the tube due to risk of drug-drug interactions 1
- Always use sufficient water (30 mL) for flushing to maintain tube patency 1
- Polyurethane PEGs may be preferable to silicone PEGs for medication administration due to better patency retention 1
Reducing Aspiration Risk
- Always maintain head elevation during and after feeding 2
- Consider conversion to gastrojejunostomy tube for patients with recurrent aspiration 2
- Schedule nebulizer treatments away from feeding times to reduce aspiration risk 2
Monitoring for Complications
- Monitor for signs of peristomal infection, which occurs in up to 30% of cases 2
- Watch for signs of buried bumper syndrome (0.3-2.4% of cases) 2
- Be alert for symptoms of aspiration pneumonia, which requires prompt management 2
By following these evidence-based guidelines for PEG tube flushing, you can minimize complications and ensure optimal delivery of medications and nutrition to your patient.