410 Connell Road
Valdosta, GA 31602

phone:(229) 244-1570
fax:(229) 247-1084

PEG Caregiver

This handout has been prepared to give the patient’s caregiver as much information as possible to help them understand the basics of tube feeding and to feel confident when caring for the patient.  Although we have tried to discuss most of the situations you may encounter, no one handout can address the specific needs of every patient in every situation.  If a problem arises in a particular situation, call your doctor or health care provider.

The general reason for feeding the patient through a tube is that the patient requires nutritional support over a long period of time.  The patient may need total nutritional support (the patient cannot eat anything and must get all nutrition from the tube feeding) or the patient may need only supplemental nutritional support (the patient can eat, but cannot get enough nutrition from meals alone).  The specific reason for your patient’s need should be discussed with the patient’s doctor.

The nutrition is given to the patient in formula containing the proper mix of nutrients to meet the patient’s needs.  The doctor has prescribed the amount and type of formula to be fed as well as the particular feeding method.  The formula is fed to the patient through a feeding tube that is placed directly into the stomach.  The feedings can be given by either bolus or continuous feeding method.  With the bolus method, the patient is fed a large amount quickly several times a day using a syringe.  The continuous feeding method provides a smaller amount of formula at a slower constant rate.  Often this is accomplished using a pump.

FEEDING THE PATIENT

Check residual:

  • Wash your hands
  • Attach a 60cc catheter tip syringe to the feeding tube.
  • Draw back on the plunger of the syringe to withdraw stomach contents or residual.  You may not get any residual if the stomach is empty.
  • However, if you pull back more than 150cc of stomach content, allow it to flow back in the stomach by gravity.
  • Hold the feeding for 2 hours.
  • Re-check the residual after 2 hours.
  • If it continues to be high, do not attempt the tube feeding and notify your doctor
  • If you notice several residuals of 150cc or more, notify your doctor; the tube feedings may need to be adjusted.
  • Be sure to give the residual back to the patient by slow gravity flow.  This helps prevent nutrient and electrolyte loss.
  • If the patient is on continuous feeding, check the residual every 4 hours.

 

Bolus Feeding Method

  • Wash your hands.
  • Check residual before bolus feeding.
  • During feeding, the patient should either be sitting or semi-erect and remain so for 30 minutes afterward.
  • Check feeding solution for expiration date.  Feeding solutions should be at room temperature.
  • Remove the plunger from the syringe and place the syringe tip in the feeding tube.
  • Pour 30cc of water into the syringe and unclamp the feeding tube.  If there is no clamp, bend the tube back onto itself.  Allow the water to go into the feeding tube to be sure that the tube is open.
  • Pour feeding solution into the syringe and adjust height of the syringe to increase or decrease the rate of flow.  Allow 15-20 minutes.
  • As the solution flows into the stomach, tilt the syringe to allow air bubbles to escape.  Air bubbles may cause discomfort in the stomach.
  • When the syringe is about ¼ full, refill the syringe with the feeding solution.  Do this as many times as necessary for the full feeding.
  • When the feeding is complete, pour 60cc of water into the tube and allow it to go into the stomach.
  • Plug the tube securely.
  • Remain in an upright position for 30 minutes.

 

Continuous Feeding Method

  • Wash your hands.
  • Check for residual every 4 hours.
  • To administer the feeding with a pump, set up the equipment according to the manufacturer’s guidelines, and fill the feeding bag.  To administer the feeding by gravity, fill the container with formula and purge air from the tubing.
  • Monitor the gravity drip rate or pump infusion rate frequently to ensure accurate delivery of formula.
  • Flush the feeding tube with 60cc of water every 4 hours.
  • Change the feeding bag every 24 hours.

 

MEDICATIONS

  • Medications can be given through the PEG tube by the bolus method.
  • Ask for medications in liquid form if possible.
  • Most pills and capsules can be crushed and dissolved in 30cc of water and then given through the PEG tube.
  • DO NOT crush enteric coated or time released medications.  Ask your doctor for instructions.

 

DAILY SKIN CARE

  • At least daily and as needed, clean the skin around the PEG site.  When healed, wash the skin with mild soap and water.  Rinse well and pat dry.
  • Look for redness, swelling, discomfort, drainage or skin irritation.
  • Rotate the external disc to change the resting position on the skin.
  • The PEG site can remain open to air once healed.  If there is drainage, a light gauze dressing may be applied.

 

SPECIAL CONSIDERATIONS

  • If the patient vomits, complains of nausea or of feeling too full, stop the feeding.  Flush the tube with water and try to restart the feeding in an hour.
  • Continue to provide oral hygiene.
  • If the PEG tube should come out, cover the site with gauze and notify the doctor.
  • Be sure the formula is at room temperature.
  • Be sure the patient is sitting up or semi-sitting during feedings and remains sitting up for 30 minutes after the feedings.

 

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