PEG tube placement is associated with significant short- and long-term risks. There is no decrease in risk of aspiration pneumonia with placement of gastric or post-pyloric feeding tube and there might be increased risk.
Can a PEG tube eliminate aspiration?
But a PEG tube can't fully eliminate aspiration. Aspiration can happen if you have trouble swallowing normally and food or liquids enter your lungs. Some common conditions in which a PEG tube may be recommended include: Birth defects. Problems swallowing. Stroke. Cancer of the mouth or esophagus. Diseases of the esophagus.
What can be given through a PEG tube?
Clear fluids, often water, will be given initially through the PEG tube 6-24 hours after its insertion. Once this is tolerated, then feeds and medications may be given through the tube. Medications can also be given through the PEG tube but care is needed as some medications can clog up the tubing. Your pharmacist will advise you with this.
Why do I need to tape my PEG tube?
If you are giving continuous drip feeding into a PEG tube you may want to tape connections to prevent disconnection of the extension set from the tube and spillage of feedings.
Will ensure clog up my PEG tube?
PEG tube is very narrow, and commercial tube feeding formulas such as Ensure, are designed so that they will not clog the tube; they are not too thick and do not leave a residue. Most formulas are designed to have water added to them to ensure that the patient is receiving enough dietary water, and to further thin the formula for ease of use.
Can you aspirate on a PEG?
Aspiration. Aspiration of stomach content/feed into the lungs can occur during insertion of the PEG tube because the oesophageal sphincter that stops gastric contents from refluxing into the oesophagus is held open by the endoscope.
Do PEG tubes prevent aspiration?
Feeding tubes do not prevent aspiration of contaminated oral secretions or regurgitated gastric contents—both well- documented causes of aspiration pneumonia. Although enteral feeding tubes are often placed to prevent aspiration pneumonia, they have long been cited as risk factors for aspiration pneumonia.
Can you aspirate while on a feeding tube?
Aspiration can happen when you're eating, drinking, or tube feeding. It can also happen when you're vomiting (throwing up) or when you have heartburn.
What is the best position to prevent aspiration?
Body positions that minimize aspiration include the reclining position, chin down, head rotation, side inclination, the recumbent position, and combinations of these. Patients with severe dysphagia often use a 30° reclining position.
Which is better NG tube or PEG?
Conclusion: PEG is a better choice than NGT feeding due to the decrease in risk of pneumonia requiring hospital admission, particularly in patients with abnormal amounts of pooling secretions accumulation in the pyriform sinus or leak into the laryngeal vestibule.
How do you prevent aspiration during intubation?
Laboratory studies have suggested that the lateral Trendelenburg position is effective in preventing ventilator-associated pneumonia. [18,19] Pulmonary aspiration may be prevented during intubation attempt by the use of a combination of the head-down tilt and the semi-lateral position.
How can you prevent aspiration during enteral tube feeding a nurse?
If unable to sit up for a bolus feed or if receiving continuous feeding, the head of the bed should be elevated 30-45 degrees during feeding and for at least 30 minutes after the feed to reduce the risk of aspiration.
How can I stop aspiration?
PREVENTION OF ASPIRATION DURING HAND FEEDING:Sit the person upright in a chair; if confined to bed, elevate the backrest to a 90-degree angle.Implement postural changes that improve swallowing. ... Adjust rate of feeding and size of bites to the person's tolerance; avoid rushed or forced feeding.More items...
What are the symptoms of silent aspiration?
This is called “silent aspiration.” You may experience a sudden cough as your lungs try to clear out the substance. Some people may wheeze, have trouble breathing, or have a hoarse voice after they eat, drink, vomit, or experience heartburn. You may have chronic aspiration if this occurs frequently.
What are some of the signs and symptoms of aspiration that need to be reported immediately to the nurse?
Nursing AssessmentCoughing, choking, throat clearing, gurgling or “wet” voice during or after swallowing.Residual food in mouth after eating.Regurgitation of food or fluid through the nares.
How long does aspiration pneumonia take to develop?
How long does it take for aspiration pneumonia to develop? Symptoms of aspiration (inhaling something like secretions) start very quickly, even one to two hours after you inhale something you shouldn't have. It may take a day or two for pneumonia to develop.
Can you aspirate sitting up?
As the trachea is in front of the esophagus while sitting up straight and the trachea is above the esophagus while leaning back or lying down, aspiration into the trachea can be reduced because of gravity.
What are the symptoms of tube feeding aspiration?
Know the signs and symptoms of tube feeding aspiration: increased blood pressure, heart rate, and respiratory rate; decreased oxygen saturation; and new onset audible rhonchi and wheezes.
What causes a patient to aspirate into the lower respiratory tract?
As many as 40% of patients receiving enteral tube feedings aspirate the feedings into their lower respiratory tract, resulting in pneumonia. Dislodged or misplaced enteral feeding tubes, high gastric residual volume (GRV), dysphagia, and poor oral hygiene are all possible causes of aspiration pneumonia.
What are some of the most common PEG tube problems?
Tube feeding has come a long way since it was first invented. Modern PEG tubes are discreet, comfortable, and relatively easy to maintain. Still, complications can arise. That’s why it’s so important for family caregivers to know how to spot common PEG tube problems, including:
How can I reduce the risk of feeding tube problems?
There’s no way to prevent feeding tube problems entirely, but there are several things you can do as a caretaker to significantly reduce your loved one’s risk, including:
What do you need to know about peg tubes?
WHAT YOU NEED TO KNOW: Healthcare providers will teach you how to put liquid food and certain medicines through the tube. You will also be taught how to care for the PEG tube and the skin where the tube enters your body.
How to flush a peg tube?
Always flush your PEG tube before and after each use. This helps prevent blockage from formula or medicine. Use at least 30 milliliters (mL) of water to flush the tube. Follow directions for flushing your PEG tube.
How does a syringe work?
The syringe is connected to the end of the PEG tube. You will pour the liquid into the syringe and hold it up high. The syringe plunger may be used to gently push the last of the liquid through the PEG tube. A gravity drip bag allows liquid food to drip more slowly into the PEG tube.
What happens if you eat a peg tube?
You have nausea, diarrhea, or abdominal bloating or discomfort. You have stomach pain after each feeding or when you move around. You have discomfort or pain around your PEG tube site. The skin around your PEG tube is red, swollen, or draining pus. You weigh less than your healthcare provider says you should.
How long do you have to leave bandages on after a tube is put in?
Your healthcare provider will take them off once the skin around your tube heals. Leave clean bandages over the tube area for the first 24 hours after the tube is put in. You may not need to use bandages after 24 hours if the skin around the tube looks dry. Ask when you can shower or bathe.
How to clean a tube?
Clean the skin around your tube 1 to 2 times each day. Ask your healthcare provider what you should use to clean your skin. Check for redness, swelling, or pus in the area where the tube goes into your body. Check for fluid draining from your stoma (the hole where the tube was put in).
How to keep a record of how much you urinate?
You may also need to keep a record of how much you urinate and how many times you have a bowel movement each day. Bring this record to your follow-up visits. Check your weight directed. Keep a record of your weights and bring it to your follow-up visits.
How does a peg tube prevent it from coming out?
Some brands have a small wire within the tube, which after insertion is pulled from the exterior end of the tubing causing the portion within the stomach to curl up or “pigtail,” preventing it from being pulled out.
What is a peg tube?
Figure 2. PEG tube – a small, flexible, hollow tube (catheter) with a balloon or flared tip is inserted into the stomach. The stomach is stitched closed around the tube and the incision is closed.
How does a peg tube work?
During the PEG tube placement procedure, a physician places an endoscope (a long, thin, flexible instrument about 1/2 inch in diameter) into your mouth. The endoscope is then advanced through your esophagus (the “food pipe” leading from your mouth into your stomach) and into your stomach.
What to do if your gastrostomy tube is dislodged?
If you do not speak to a doctor or nurse after thirty (30) minutes, go to nearest emergency room in a hospital for tube reinsertion (make sure you bring your gastrostomy supplies with you).
How long does a peg tube stay in your stomach?
They may be needed temporarily or permanently. The PEG tube which is made of silicone, must stay in the stomach for about three months to allow the tract (hole) to heal between the abdomen and the stomach. The tract must be well healed so it is safe for the gastrostomy tube to be changed.
What are the complications of a peg tube?
Possible complications include pain at the PEG site, leakage of stomach contents around the tube site, and dislodgment or malfunction of the tube. Possible complications include infection of the PEG site, aspiration (inhalation of gastric contents into the lungs), bleeding and perforation (an unwanted hole in the bowel wall).
Why is my PEG pulled out?
Excessive tension may also cause the tube to be pulled out prematurely. If the tube becomes too loose, spacers, may be placed between the PEG and the skin to provide a better fit. If the tube gets too tight and there are spacers in place, these can be removed anytime, by your GI nurse or doctor.
What is the use of a peg tube?
Use of the PEG tube for feeding begins gradually with clear fluids and progresses to special formula feedings. There is a lot to learn about using and caring for a PEG tube. You will need to work closely with your medical team. The team may include healthcare providers, pharmacists, and nutrition specialists.
What happens during a peg tube placement?
PEG tube placement is usually done under local anesthesia and sedation. You will have an IV (intravenous) line started in your hand or arm so you can receive fluids and medicines.
How is a peg tube inserted?
The PEG tube is inserted through the opening while the healthcare provider watches through the endoscope. The tube is held in place inside your stomach with the help of a special balloon or a cap. A small dressing is placed at the new opening.
How long does a peg tube stay in your stomach?
The PEG tube can stay in your stomach for months or years so you can take fluids, medicines, and nutrition through it when you can’t take in enough by mouth. Once you have this type of tube, it is important to let your healthcare provider know if the tube comes out because the opening will close quickly.
What causes aspiration in the lungs?
Aspiration can happen if you have trouble swallowing normally and food or liquids enter your lungs. Some common conditions in which a PEG tube may be recommended include: Birth defects. Problems swallowing. Stroke. Cancer of the mouth or esophagus. Diseases of the esophagus.
How long does it take to get a syringe out of your stomach?
The actual procedure takes about 20 minutes. This is what usually happens during the procedure: The skin over your belly is cleaned and a numbing medicine is injected. The endoscope is passed through your mouth into your stomach. A small surgical cut is made through your skin and into your stomach.
What are the risks of a tube in the belly?
Aspiration. Bleeding from the incision area. Bleeding or infection from damage to other organs inside the belly. Blockage or dislodging of the tube. There may be other risks, depending on your specific medical condition.
What Would You Do in This situation?
History and Assessment Hints
- Two hours after admission, you enter Ms. Jecker’s room and find her alone, with her feeding tube lying on her chest. She’s restless, coughing, and struggling to catch her breath. Concerned that she’s aspirated the tube feeding, you activate the rapid response team (RRT) and ask the charge nurse to notify the neurosurgery team.
on The Scene
- While waiting for the RRT, you place Ms. Jecker on a facemask at 10 liters per minute of oxygen. Her vital signs are BP 145/92 mmHg, HR 117 bpm, RR 38 breaths/ minute, and oxygen saturation 88%. The RRT arrives, and you assist them in positioning the patient’s bed at 90 degrees. Kim, the RRT nurse, auscultates Ms. Jecker’s lung fields and says that she hears wheezes and rhonchi th…
Outcome
- In the ICU, Ms. Jecker undergoes a bronchoscopy to visualize and suction her lungs to obtain a specimen for culture and sensitivity for any organisms. The provider orders I.V. ceftriaxone; Ms. Jecker remains confused and lethargic. To avoid the dangers of dislodging another feeding tube, a percutaneous endoscopic gastrostomy is placed, and tube feedings are resumed. After 4 day…
Education and Follow-Up
- As many as 40% of patients receiving enteral tube feedings aspirate the feedings into their lower respiratory tract, resulting in pneumonia. Dislodged or misplaced enteral feeding tubes, high gastric residual volume (GRV), dysphagia, and poor oral hygiene are all possible causes of aspiration pneumonia. Enteral nutrition practice recommendations include maintaining head-of-…
Selected References
- AACN Practice Alert: Initial and ongoing verification of feeding tube placement in adults (applies to blind insertions and placements with an electromagnetic device). Crit Care Nurse. 2016;36(2):e8-14. Emergency Nurses Association Clinical Practice Guideline: Gastric tube placement verification. 2018. ena.org/docs/default-source/resource-library/practice-resources/c…