LECTURE 2 (PEG and RIG tube)

Question 1

What is a Percutaneous Endoscopic Gastrostomy (PEG) tube?

Answer 1

A surgery to place a feeding tube which allows the patient to receive nutrition through the stomach. It is usually needed if patients have difficulty swallowing or can’t get enough nutrition they need by mouth.

Question 2

Who needs a PEG tube?

Answer 2

Patients with
- Brain injury
- Head and neck cancer
- Stroke
- Chronic appetite loss due to severe illnesses (e.g cancer)
- Oral surgery
- Anorexia

Question 3

Describe PEG tube care

Answer 3

• First change of dressing should be 24 hours after PEG placement/earlier if indicated (e.g bleeding)
• Until granulation of stoma canal has taken place, dressing should be changed DAILY using aseptic technique (first 10 days)
• Wound should be inspected for bleeding, erythema, secretion, induration & allergic skin reaction

Question 4

What are the complications of PEG tube insertion?

Answer 4

• Infection
• Pain/discomfort
• Pressure necrosis (due to excessive tightening of external fixation device)
• Hyper-granulation (excess movement of the tube within the tract may stimulate growth of granulation tissue)
• Buried bumper
• Peristomal leakage
• Pneumoperitoneum

Question 5

Describe the immediate care

Answer 5

• OBS (BP, pulse, RR and pain score) + site checks for bleeding, leakage of gastric contents or tube displacement
• Signs of peritonitis/tube displacement -> contact medical team immediately
  [Peritonitis manifests as abdominal pain, fever and raised WBC]
• Pain on feeding, prolonged/severe pain post procedure of fresh bleeding -> stop feed immediately + contact doctor
• Aspiration pneumonia, haemorrhage and wound infection

Question 6

What is a Stoma?

Answer 6

An opening on the abdomen that can be connected to either the digestive or urinary system to allow urine or faeces to be diverted out of the patient’s body

Question 7

What is the cause, prevention and action of a displaced PEG bumper?

Answer 7

CAUSE:
- excessive tension being applied to tube

PREVENTION:
- support the tube beneath the fixator when moving

ACTION:
- lease with medical team

Question 8

What is the cause, prevention and action of Tube failure?

Answer 8

CAUSE:
- prolonged use of clamp without moving faulty tube

PREVENTION:
- regular tube care and review
- change position of clamp regularly

ACTION:
- liase with medical team for replacement

Question 9

What is the cause, prevention and action of Tube blockage?

Answer 9

CAUSE:
- inadequate tube flushing or overuse for administrating medications

PREVENTION:
- regular tube flushing
- avoid/minimise use of tube for medications