Preventing Complications in Peg Feeding: Strategies and Best Practices
Preventing Complications in Peg Feeding: Strategies and Best Practices
PEG feeding is a method for providing nutrition and medication through a tube, which can be lifesaving when done correctly. Unfortunately, complications may arise during this procedure.
Infections and blockages in the tube can be problematic. This article aims to prevent these complications by providing strategies and best practices for managing the tube properly.
1. Keep the Tube Clean
PEG feeding is an enteral nutrition technique where food and fluids are delivered into your stomach through an endoscope tube. This may be necessary when having difficulty swallowing or having a blockage in either your esophagus or stomach.
Your doctor will use an endoscope to make a small incision through the skin and into your stomach, known as a percutaneous endoscopic gastrostomy (PEG).
Maintaining the tube should always be kept clean and dry to reduce the risk of infections that could develop if not handled properly.
First and foremost, wash the area around your tube with soap and water. Additionally, you may use antibacterial ointment or Neosporin for added protection. Do this at least once to twice daily, more frequently if there is visible drainage from inside or outside the tube.
Another important step is to flush the tube after eating or drinking. Doing this removes any residue from food and drinks, helping prevent clogging and infection. Do this 1-2 times a day using a 60 mL syringe filled with warm water.
If there's a problem with your PEG, contact your healthcare provider right away for advice and the appropriate course of action. They may suggest an alternate method for cleaning the tube as well.
Before and after placing your PEG tube, you may need to take antibiotics or other medicines. These can help protect against infections and extend the life of your PEG tube.
Infections are a common side effect of peg feeding training. Be on the lookout for any unusual redness, swelling or pus around your tube and report any unexplained fever, pain, swelling or other symptoms to your healthcare provider.
Other serious complications can arise if you fail to adhere to the instructions for taking care of your tube. Such issues, such as an esophageal stricture in your stomach (known as an esophageal stricture), require surgery for repair.
It is essential to avoid buried bumper syndrome, in which the external bolster of your tube moves away from your stomach and becomes buried in there. This could result in gastric outlet obstruction or other problems.
2. Flush the Tube Regularly
It is essential to flush your PEG tube regularly. Doing so helps prevent it from becoming clogged and leaking. Flush the tube before and after each feeding as well as with any medications given through it.
You can flush the tube with a syringe that has been filled with warm water. Your child's doctor will advise how much water to use.
Some medications administered through your tube may clog or get kinked, so it is essential to flush it regularly. You could also try adding Coca Cola(r), cranberry juice or water with meat tenderizer to loosen up the tube if your doctor suggests this is done. If that doesn't work, contact our office for further instructions.
Your doctor can demonstrate how to flush the tube using a special syringe. This syringe has a nozzle that you insert in the tube and a plunger. When you push on it, the plunger will move up and down, allowing you to draw up any water present.
When administering injections to your child, it's best to use a syringe that has been prescribed by their doctor. You may also use one from home - just make sure it has been cleaned and disinfected with alcohol or another antiseptic before use.
Syringe should be connected to the NG port on your child's tube. Use a syringe that measures at least 2 ml (cc) in size.
Before each feeding and with each medicine administered via it, it is important to flush the NG port. Furthermore, you should do so after each feeding as well.
Aspiration pneumonia is a relatively common adverse reaction to PEG feeding. It poses an especially high risk for those who are debilitated or have an underlying medical condition that could slow wound healing.
Aspiration pneumonia is a potentially lethal infection that can occur if left untreated. To minimize the risk, keep the tube clean and dry between feedings, flush it with a syringe filled with water after each feeding, as well as after administering any medications to your child.
3. Keep the Stoma Clean
If your loved one is on tube feeding, it is essential that the stoma (the opening in their abdomen where the tube connects to their stomach) be kept clean. Doing so can prevent infections and blockages associated with PEG feeding.
If you don't regularly clean your care recipient's stoma, they could develop an infection or seep blood or pus. This can make the area painful and sensitive. If you notice any of these symptoms in your recipient, reach out to their doctor right away for further evaluation.
Another potential issue that can occur with PEG feeding is buried bumper syndrome. This occurs when the internal bumper (the part of the tube that extends into your stomach) becomes trapped within either your stoma tract or mucosa. It's a serious condition requiring immediate medical attention and could result in pain, infection and even loss of your PEG tube as a source of nutrition.
The most common symptom of BBS is swelling or pain near the stoma site, which may spread to other parts of the body. Additionally, it can lead to a skin infection that requires antibiotics for treatment.
Your care team can assist in keeping your stoma clean and healthy, so you won't have to worry about any potential complications from PEG feeding. They offer tips on keeping the area sterile and dry as well as advice on how to remove any blood or pus that may ooze out during PEG feeding.
You may wish to remove granulation tissue at the stoma, which is extra skin that grows around it. Although not uncommon, this condition can be irritating and require treatment with foam dressings or silver nitrate.
To reduce the risk of granulation tissue, use gauze pads on the tube when washing your care recipient's stoma and don't move it while cleaning it. Furthermore, try not to exert too much traction on it as this could increase ischemia and slow wound healing.
If your care recipient's stoma oozes blood or feels extremely uncomfortable, contact their doctor or go directly to the ER. Oozing can be caused by food, medication, or stomach acids and should never be ignored.
4. Keep the Tube in Place
Tube feeding is an effective way for patients who struggle to consume enough calories and water. Your healthcare provider will determine the appropriate amount and type of formula and liquid required to meet your nutrition and hydration requirements.
Your healthcare provider will instruct you on how to use your tube properly. This may involve using a special pump or giving several measured feedings throughout the day. Additionally, keep track of all liquids consumed and drank. Your healthcare provider may need to adjust your feedings if your weight fluctuates too rapidly or there are issues with the tube itself.
Additionally, you should clean the skin surrounding your tube once or twice daily to help avoid infection or blockages in the tube. Speak to your healthcare provider about medications you can take to lower the risk of such complications as infection or blockages.
Infections are a common risk associated with PEG feeding. To minimize your chances of contracting an infection, keep your stoma clean and dry and use topical medicines as prescribed to keep it moisturized.
If your PEG tube becomes clogged, it can prevent you from getting essential nutrients and water. To unclog it, fill a 60mL syringe with warm water (not using a wire). If this doesn't work for you, speak to your healthcare provider about using medicine or using a plastic brush instead.
If your tube dislodges, it can cause severe pain and bleeding. This could happen if it moves into your intestines or if you aspirate (accidentally inhale) stomach contents. In extreme cases, this could even lead to perforations (holes in the wall of your bowel or intestine).
Other mechanical difficulties include clogging, which can disrupt nutrient and medication delivery. Clogs can be caused by medications or mucus buildup inside the tube.
Diagnosing and managing these complications can be challenging, but your healthcare provider can offer tips to help you avoid them.
In addition to keeping the tube from becoming clogged, your healthcare team can suggest medications or dietary changes that may reduce gas and constipation. They may also suggest venting or burping your tube in order to release excess air and pressure.
