PERCUTANEOUS ENDOSCOPIC

GASTROSTOMY (PEG)

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

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

Endoscope

Gastrostomy

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

PURPOSE:

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

ASSESSMENT:

Assess the client signs of gastric distress, such as nausea, vomiting, and cramping

Assess the feeding tube placement every 4 hours

Assess the client’s respiratory status Assess the client’s ongoing nutritional

status Assess the client’s intake and output

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 client’s weight and nutritional status will remain stable or improve

The client will not experience any adverse skin or gastrointestinal effects from the gastrostomy or PEG tube.

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

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 Observe for abdominal distention ;

auscultate for bowel sounds

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

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

INTERMITTENT GAVAGE FEEDING

Hang bag on Iv pole so that is it 18 inches above the client’s head

Remove air from bag’s 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

Change bag every 24 hours

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

Adjust drip rate

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

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.

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.

Client’s weight and nutritional status remained stable or improved

Client did not experience any adverse skin or gastrointestinal effects from the gastrostomy or PEG tube.