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Swallowing, eating and nutrition

5) Percutaneous Endoscopic Gastrostomy (PEG)

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This film shows the basic tasks and use of a PEG tube. PEG stands for Percutaneous Endoscopic Gastrostomy. This is a tube which goes directly in to the stomach following a simple surgical procedure. It is used as the main way to take food, drinks and medicines for people who are unable or who have an unsafe swallow by mouth after a stroke. Wash your hands before using the PEG tube.

Here are all the items you will need

  • The correct medication.-(Most medications will be issued in liquid form. Some are not available in this form and you will be given instructions from the hospital staff on how to prepare them for giving by the PEG tube.)
  • Ready made feed at room temperature.
  • A clean jug.
  • Medicine containers.
  • Small and large syringes which can be used for 1 week. They are washed in hot soap water and air dried. They are also dishwasher safe.
  • Disposable wipes/ paper towel.
  • A clean towel.
  • Medicine measuring spoons.
  • Water in a clean container.

These are the parts of the PEG tube.
The Y connector. This has two parts. The feed port and the medication port.

Further down the tube is the clamp which can be pressed in to close the PEG tube or released to allow the feed or medication to pass down the tube.

This model shows the fixation device which holds the tube close to the skin. It is important that this should be released and cleaned each day.

The Fixation device should be loosened so that the skin surrounding it can be cleaned gently but thoroughly with unscented soap and water. Do not apply creams or powders to the area unless advised to by your doctor.

Disposable wipes (not baby wipes) or clean gauze should be used and the skin should be Rinsed and dried well. Do not to pull on the tube as you clean this area.

Remember to replace the tube in the fixation device and rotate the tube 360 degrees each day. This will prevent the hole from closing or sticking and it will be more comfortable. Reconnect the fixation device.

How to give medication
First start by clamping the tube this will stop any stomach contents from spilling from the tube. Always start and end any feeding or medication giving by flushing the tube with 30 ml of water. For this volume we use the FEED port.
Open the feed port and attach a clean large size syringe. Use 30 mils of water to flush the tube before giving any medication. Unclamp the tube until the water has drained down the tube. This method is called GRAVITY Close the stopper and re-clamp the tube.

Depending on the thickness or type of medicine, you may have to dilute it so it will pass easily down the PEG tube.
Here we see a thick suspension. This could block the tube or be difficult to flush unless it is diluted with water. Stir well.

Thinner medicines may still need to be diluted. It is important to measure the correct dose carefully. This is a syrup Once the water is added, stir well.

If the person has been given fizzy or soluble medicine as an alternative to tablets, these should be made up with the recommended amount of water. Make sure they are fully dissolved before putting into the syringe these can be given just like the 30ml flush, using GRAVITY because of the volume of liquid.
Crushed tablets should NOT be put down a PEG tube unless you have been instructed to do so by hospital staff. They could cause a blockage. If in doubt ask your local pharmacist which medications can be crushed or diluted.

For smaller volumes of medication Use the smaller syringes if you wish. Make sure all the medicine is in the syringe. Remember to squeeze as much air out of the syringe as you can without spilling any medicine. Putting air into the PEG tube can make the person feel uncomfortable and bloated and air could block the tube.

Clamp the tube Take the stopper off the medication port. Attach the syringe unclamp the tube then push the medication in to the tube slowly with the plunger. Give each medicine separately with a 10 mil flush of water between each one. Remembering to clamp and reclamp the tube between each medication and flush of water. Replace the stopper at the end of the medication port.

After giving all the medication, you should put another 30 mils of water into the tube to flush through any remaining medicine. Close the feed port and the clamp. The end of the Y connector may be sticky so clean it with wet wipes or clean damp disposable gauze. Wash your hands.

To give a feed
There are two ways of feeding- PUMP feeding and BOLUS feeding. You will have been instructed on the best methods for you by hospital staff.
The feed comes ready made in sealed containers like this. This method is called Bolus feeding. The person should be sitting in an upright position. See the instructions on the package for storage instructions. Check the use by date on the pack before giving the feed.
Pour the correct amount for one meal into a clean jug. The amount required at each meal will be instructed by dietician.

Clamp the PEG Tube Remove the stopper from the feed port, attach a large syringe. Flush the tube with 30mils of water first. Clamp tube then fill the syringe with the feed and unclamp the tube. As you can see the feed will drain slowly with gravity. It is important not to try and rush this. It should take about the same time as it would to eat a normal meal, about 15 to 25 minutes.

You can use the clamp to regulate the speed which the feed goes down the tube- (or add this part below)

Remember to leave a few mils of the feed in the syringe so no air goes down the PEG tube. Add more of the feed to the syringe. Repeat until all the feed has gone. You should then flush the tube with 30 mils of water before clamping the tube. Replace the stopper on the feed port and clean the Y connector.

If you have any questions about PEG feeds or giving medication via a PEG tube ask to speak to your nurse, dietician or doctor.

To store the feed

  • Unopened feed at room temperature.
  • A cool dry cupboard is ideal.
  • Not near heat or direct sunlight.
  • Not outside as in winter it may freeze.
  • Once opened, store in fridge but remember to take the next “feed” out of the fridge to warm to room temperature.
  • Opened Sterile feed can be kept for up to 24 hours.
  • Discard any unused feed which has been opened after 24 hours.

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