Percutaneous Endoscopic Gastrostomy (PEG) Feeding Tube (Nursing)

by Samantha Rhea, MSN, RN

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    00:00 Welcome to Percutaneous Endoscopic Gastrostomy Tube or otherwise known as PEG tube.

    00:10 It's a lot of words. You're typically going to hear it called a PEG tube. Now the difference with this tube is that it's usually used for long-term nutrition or medication delivery. You can have a PEG tube for months. Now, this is going to differ from what you may hear of a nasogastric tube, for example. Now, nasogastric tube is usually used for short-term usage, a PEG tube is used much longer for nutrition and medication delivery. So let's take a closer look at our PEG tube. Now, what differs here is it passes directly through the abdominal wall into the stomach. Initially when a gastrostomy tube is placed, it's placed endoscopically by a gastroenterologist. Now once the stoma is established, featured tubes may not need endoscopic placement. Now this is the case because usually it's already established where the PEG tube is already been, so typically we can just replace it if we need a secondary tube because maybe it was pulled out. Let's take a closer look at the anatomy of a PEG tube.

    01:17 So let's focus here on the internal and the external crossbar that you see. If you look at the internal crossbar, this is going to help the PEG tube anchor to the stomach wall. Now if you take a look at the external crossbar, this is the one that's going to set directly on top of the skin of the abdomen. This is also going to help anchor. Now one thing to note, if you look at the internal crossbar, some tubes may be placed with a balloon here that's also going to help anchor in the PEG tube. Now if we take a look here at the top, this is a clamp that helps close off the feeding tube if we need to do so. Now, let's look at this last part here at the top of the PEG tube. There are 2 ports usually at the end of the PEG tube. You're typically going to see a larger one up top. Now this one is usually for feeding and medications for example.

    02:09 You also may see a small port to the side and this is going to help to inflate or deflate the balloon if we need to. So what you're seeing here is an abdominal binder. So, all these pieces is elastic piece of fabric that wraps around the abdomen. Now, this is really helpful because if you see that last section we just looked at, that last image, there's a piece of the tube that's outside of the stomach wall. So we don't want that caught up or pulled out, so the abdominal binder is used just to help camouflage that tube and even keep the patient from pulling out your PEG tube. So this just also helps secure it in place, promote some independence, also can be used nicely under clothing or something like that if you need it. Now keep in mind, this should be snag around your patient but we don't want it so tight that it impedes breathing or induces gastric discomfort. Now that we've talked about the anatomy of a PEG, let's take a little bit closer look about nursing care. So it's to be expected that drainage from around the PEG tube itself is pretty common the first couple of days. So this could look a little icky. Sometimes it may be a little mucosy, there may be a little bit of blood, but this is to be expected in the first 1 or 2 days when the PEG tube is initially placed. So we need to keep an eye on skincare here. It should heal in about 2 to 3 weeks. So how do we take care of that new PEG? We'll take a look at the skin around the PEG and make sure we clean it at least about 1 to 3 times a day. It's really good to use just mild soap and water, for example, or even sterile saline. And a lot of the times you can use a cotton swab or gauze to help keep that dry and help absorb some excess moisture. Now if there's any drainage or crusting, you want to be really careful and be gentle about removing this. And again, if you use soap, gently clean and rinse with plain water, and make sure you want to dry the skin really well with a clean towel or gauze. We don't want a lot of excess moisture underneath that external disc in the skin because that can really cause some excoriation. And try to take care not to pull on the tube itself or prevent it from being pulled out. And we talked about earlier that abdominal binder, this can be really helpful to camouflage it from your patient or from the tube to get caught and get yanked out. Now, for the first 1 to 2 weeks, a healthcare provider may ask you to use sterile technique when caring for the PEG tube. Now this is important because if you think about the PEG tube is entering into the abdominal cavity of the patient, this definitely opens it up for infection.

    04:53 So why sterile technique may be needed here. Now let's talk about some weird abnormal assessments for a client with a PEG, some weird things that may come up that we need to be mindful of. So, the feeding tube may have come out of the abdominal wall. There could be leakage around the tube or the system itself. There could be a lot of redness, irritation on the skin around the area of the tube. And the feeding tube could even be blocked. Now, this is the other thing to consider and to watch, if there are a lot of bleeding from the insertion site around the tube. Now when you start new tube feedings, for example, there could be a lot of diarrhea from the patient and we need to be conscientious of that. Also, if there's a hard or a swollen belly 1 hour after feedings, you need to stop feedings and notify the care provider. Now, with a new PEG, keep in mind a patient may have worsening abdominal pain, this also should not occur and you want to talk to your healthcare provider.

    05:59 Constipation, passing hard dry stools could also occur. We also want to make sure our patient's nice and hydrated to keep this from occurring. If the patient starts coughing more than normal or feels short of breath after feedings, this could be an indication that a patient is aspirating or it has backed up into their lungs. This is a definite stop and we need to notify the healthcare provider. Now, if you notice feeding solution is coming out of the client's mouth, this is a bad sign. If you think about it when we've talked about it earlier that PEG tube is going directly into the stomach where we're giving the feeding. So therefore we are bypassing the mouth and you should not see tube feeding coming out of the client's mouth.

    About the Lecture

    The lecture Percutaneous Endoscopic Gastrostomy (PEG) Feeding Tube (Nursing) by Samantha Rhea, MSN, RN is from the course Enteral Feeding Tubes (Nursing).

    Included Quiz Questions

    1. One to three times a day
    2. One to two times a week
    3. Once every two days
    4. Four to seven times a day
    1. “PEG tubes are typically secured by sutures to the stomach lining and abdominal wall.”
    2. “I can clean the PEG tube site with sterile saline or mild soap and water.”
    3. “Depending on the healthcare provider, I may need to use a sterile technique when caring for a client’s PEG tube site.”
    4. “PEG tubes are usually sited in client’s requiring long term tube feeding and medication administration.”
    1. If the client has a hard, swollen belly one hour after the feeding.
    2. If the feeding solution is coming out of the client’s mouth.
    3. If the client is frequently coughing or complaining of shortness of breath
    4. If there is drainage around the tube site one to two days after insertion.

    Author of lecture Percutaneous Endoscopic Gastrostomy (PEG) Feeding Tube (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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