Percutaneous Endoscopic Gastrostomy (PEG)

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a surgical procedure for placing a tube for feeding without having to (laparotomy).

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Percutaneous

pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue
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Endoscope

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Gastrostomy

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is a surgical procedure for inserting a tube through the abdomen wall and into the stomach. The tube is used for feeding or drainage.

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PURPOSE:

Enteral nutrition where liquid food formula is directly instilled into the stomach and small intestine.
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ASSESSMENT:

Assess the client signs of gastric distress, such as nausea, vomiting, and cramping Assess the feeding tube placement every 4 hours Assess the clients respiratory status Assess the clients ongoing nutritional status Assess the clients intake and output

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PLANNING / EXPECTED OUTCOMES:

The client will receive the correct feeding formula and the correct volume of formula over the correct period. The client will not experience any undesirable effects: aspiration, nausea, vomiting, abdominal distention, cramping, diarrhea, or constipation The clients weight and nutritional status will remain stable or improve

The client will not experience any adverse skin or gastrointestinal effects 5/14/12

MATERIALS:

Asepto syringe or 20 to 50ml syringe Emesis basin Clean towel Disposable gavage bag and tubing Formula Infusion pump for feeding tube Water Disposable gloves

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IMPLEMENTATION:

Review medical records for formula, amount and time Identify client , Introduce self and explain the procedure. Assemble all the materials needed Position client on right side in high fowlers position Wash hands and Don gloves Provide for privacy for abdominal distention ;

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Check feeding tube. Insert syringe into adapter port, aspirate stomach contents, abd determine amount of gastric residual. If residual is greater than 50 to 100 ml, hold feeding until residual diminishes. Instill aspirated contents back into feeding tube. Administer tube feeding

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INTERMITTENT BOLUS

Pinch the tubing Remove plunger from barrel of syringe and attach to adapter Fill syringe with formula Allow formula to infuse slowly; continue adding formula to syringe until prescribed amount has been administered Flush tubing with 30nto 60 ml or prescribed amount of water

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INTERMITTENT GAVAGE FEEDING

Hang bag on Iv pole so that is it 18 inches above the clients head Remove air from bags tubing Attach distal end of tubing to feeding tube adapter and adjust drip to infuse over prescribed time When bag empties of formula, add 30 to 60 ml or prescribed amount of water; close clamp bag every 24 hours

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CONTINUOUS GAVAGE

Check tube placement at least 4 hours. Check residual at least 8 hours If residual is above 100ml, stop feeding. Add prescribed amount of formula to bag for a 4-hour period;dilute with water if prescribed Thread tubing through feeding pump and attach distal end of tubing to feeding tube adapter; keep tubing straight between bag and pump

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Monitor infusion rate and signs of respiratory distress or diarrhea Flush tube with water every 4 hours as prescribed or following administration of medications Replace disposable feeding bag atleast every 24 hours, in accord with institution protocol. Elevate head of bed atleast 30 degrees at all times and turn client every 2 hours Provide oral hygiene every 2-4 hours

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Administer water As prescribed with and between feedings Remove gloves and wash hands. Record total amount of formula and water administered on intake and output form and clients response to feeding.

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EVALUATION:

Clients received the correct feeding formula and correct volume of formula over the correct time period Client did not experience any undesirable effects such as aspiration, nausea, vomiting, abdominal distention, cramping, diarrhea or constipation.

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Clients weight and nutritional status remained stable or improved Client did not experience any adverse skin or gastrointestinal effects from the gastrostomy or PEG tube.

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