How To Use And Care For Your Peg Tube

WHAT YOU SHOULD KNOW:

A percutaneous endoscopic gastrostomy (PEG) tube is a soft, plastic tube that is put into your stomach through your skin. A PEG tube may be used to feed you or for decompression. Decompression is when air or liquid is let out of your stomach. A PEG tube that is used to give you food and liquids may help you gain weight. A PEG tube that is used for decompression can help decrease vomiting, and stomach pain.


AFTER YOU LEAVE:

Take your medicine as directed.

Call your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Take your medicines as ordered:

Talk to a caregiver about your medicines. Learn which of your medicines can be mixed with water and given through the PEG tube. Certain medicines do not work as they should if they are crushed. Other medicines may clog the PEG tube. Ask your caregiver if your pill medicines can be crushed and given through the PEG tube, and what equipment to use for crushing them. Ask your caregiver if you can open capsule medicines and give them through your PEG tube.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

Formulas used for tube feedings:

The following are types of formulas that may be used:

  • Ready-made formula: All formulas contain carbohydrates, fats, proteins, and water. Certain formulas may be lactose-free, gluten-free, or low in fat or sugar. Some formulas are made for a specific disease, condition, or treatment. Ask your caregiver which kind of formula is right for you. You may need to add extra carbohydrates, protein, fat, or fiber to the formula.

  • Blenderized formula: In some situations, you may be able to use a blenderized formula. Blenderized formulas are made from pureed foods. This type of formula can be bought ready-made with added vitamins and minerals, or you can make it at home. Ask your caregiver if you can use blenderized formula. The use of homemade blenderized formulas increases your risk for diarrhea and infection. Blenderized formulas may not have all of the nutrition that your body needs. They also require a larger feeding tube and increase the risk of tube clogging.

How to give formula through the PEG tube:

Caregivers will teach you how to do your feedings for the type of formula, feeding system, and PEG tube you have. The following are general directions for using a PEG tube to feed yourself:

  • Wash your hands: Wash your hands before you get the formula ready or use the PEG tube. Use soap and water. Wash up to your elbows. This helps prevent germs from getting into the formula and causing infection and illness.

  • Sit upright: Sit upright while you give yourself the formula, liquid, or medicine through the tube. If you are in bed, raise the head of your bed 45 degrees to sit with your head up. You may also prop yourself up with pillows. This will decrease the risk of aspiration. Aspiration is when formula gets into your airways. Aspiration can cause coughing and lead to a lung infection.

  • Flush the tube: Flush your PEG tube with water before you start the feeding.

  • Wipe the formula lid: Use a new alcohol pad to wipe the lid of the formula. This removes germs and helps prevent infection.

  • Add the formula: Put the correct amount of formula into the syringe, bag, or pump.

  • Flush the tube: After the formula has been given, flush your PEG tube with water. If you have continuous feedings, flush the tube every 4 hours.

  • Stay sitting upright: Sit upright or keep the head of your bed raised up for 1 hour after you feed yourself.

How to store formula and care for feeding equipment:

  • Formula: Store unopened, prepared formula in a cool, dry, dark place until you are ready to use it. Ask your caregivers when to throw away leftover formula.

  • Feeding equipment: Ask caregivers how to care for or clean your feeding equipment. Continuous feeding bags and tubing should not be used for more than 24 hours. Feeding bags and tubing used for intermittent feedings should be replaced with a new set every day.

How to give medicine through the PEG tube:

What you need to do:

  • Do use a clean syringe, at least 30 milliliters (mL) in size, to give medicine through a PEG tube.

  • Do sit upright while you give yourself medicine through the tube. If you are in bed, raise the head of your bed 45 degrees. You may also prop yourself up with pillows.

  • Do stop a continuous tube feeding before you give medicine. Flush the tube with 15 mL (about 1 tablespoon) of water before you give the medicine.

  • Do flush the tube with at least 15 mL of water before and after giving medicine between intermittent or bolus tube feedings.

  • Do give each medicine separately through the PEG tube, if you are giving more than one. Flush the tube with at least 15 mL (about 1 tablespoon) of water before and after giving each medicine.

  • Do ask your caregiver which medicines can and cannot be crushed. If you are giving a pill that can be crushed, crush it into a fine powder before mixing it with sterile water. For medicine in a capsule, open the capsule and mix the medicine with sterile water. Then pour it into the PEG tube.

  • Do use the right amount of sterile water to dilute (thin) the medicine as directed by your caregiver. Ask your caregiver where to get sterile water, or if you can use cool tap water that has been boiled.
What you should not do:
  • Do not mix medicine into formula. The medicine may not work the way it should if it is mixed with formula. This also increases the risk of clogging the PEG tube.

  • Do not mix different medicines together. Medicines that are mixed together may not work the way they should and can cause serious harm. They may also clog the PEG tube.

  • Do not forget to reattach and restart a continuous tube feeding right after you finish giving medicine and flushing the PEG tube. If your caregiver tells to you to wait for a certain amount of time before you reattach the tube, set a timer to remember to do it.

Flushing the PEG tube:

  • Whenever you use your PEG tube for feeding or medicine, you always need to flush it with water.

  • When you flush your PEG tube, you help to keep it from getting clogged. This will also help to make sure that you get the full dose of medicine when you take it. Ask your caregiver about what type of water you should use to flush your tube.

  • The amount of water used to flush the tube is usually at least 30 mL or about 2 tablespoons. Follow your caregiver's directions for flushing your PEG tube.

  • Flush your PEG tube with water both before and after the formula or medicine is put in it. If you give medicine with a feeding, use water between the medicine and the formula. The order for this is: water-medicine-water-formula-water.

How to care for the PEG tube:

Ask your caregiver to show you how to care for your PEG tube.

  • Check it: Check the bumper (piece that goes around the tube, next to your skin). It should be snug, but not too tight, against your skin. Tell your caregiver if the bumper seems too tight or too loose. Check your PEG tube often to see if the length of the tube has changed. Check the tube from the end of it to where it goes into your body. If it gets longer or shorter, let your caregiver know right away. If your tube comes out, it needs to be replaced right away.

  • Clean it: Clean the hub (tube opening) of your PEG tube daily. This is where the tube attaches to the feeding equipment. Ask your caregiver what you should use to clean the tube hub. Do not let the end of the PEG tube touch anything when you disconnect it from a syringe or tube. Use a new alcohol pad to wipe off the end of the PEG tube. Do this before you connect anything to your PEG tube and after you disconnect anything from your PEG tube.

  • Unclog it: Flush your PEG tube with warm water if it is clogged. You may use a special medicine or have a special plastic brush to help unclog your tube if needed. Ask your caregiver how to use it. Never use a wire to unclog the tube. A wire can poke a hole in the tube.

How to care for the skin around the PEG tube:

  • Clean your skin: Clean the skin around your tube 1 or 2 times each day. Ask your caregiver what to use to clean your skin. Check for redness and swelling in the area around your stoma (hole where the tube goes into your body). Check for fluid draining from the stoma.

  • Keep your skin dry: Follow your caregiver's instructions about using clean bandages around the tube area. You may need to do this for the first 24 to 48 hours (1 to 2 days) after the PEG tube is put in. After 24 to 48 hours, you should not use bandages if the skin around the tube is dry.

  • Turn the tube: If there are no stitches holding your PEG tube in place, gently turn the tube. This may decrease pressure on your skin. It may also help prevent an infection. Ask your caregiver how to turn your tube correctly.

  • Use skin medicines as directed: If you are having problems with fluid coming from your stoma, you may need to put barrier cream on the skin around your tube after you are done cleaning it. If you get an infection, you may need to put antibiotic (germ-killing) cream on the skin around your tube. Your caregiver may also give you antibiotic medicine to take as pills.

What else to know about having a PEG tube:

  • Intake and output: Your caregiver may tell you to keep track of how much formula and other liquids you have every day. You may need to keep track of how much you urinate and how many times you have a bowel movement each day. Write this information down to show your caregiver during follow-up visits.

  • Weight checks: Your caregiver may tell you to check your weight daily or weekly. Write the number down to show caregivers. Your caregiver may need to change your feedings if your weight changes too quickly.

  • Residual formula: Your caregiver may tell you to check for formula that remains in your stomach. This is called a feeding residual. Your caregiver will show you how to do this. You may need to do this before you give a bolus or an intermittent feeding.

Contact your caregiver if:

  • You have stomach pain after each feeding or when you move around.

  • You have diarrhea or are constipated.

  • Your mouth feels dry, your heart feels like it is beating too fast, or you feel weak.

  • Your weight changes more than what your caregiver has told you it should.

  • You have a fever.

  • The skin around your PEG tube is sore, red, or swollen, or there is pus coming out of the stoma (hole where the tube goes into your body).

  • You have formula, medicine, or drainage coming out from around your PEG tube.

  • Your symptoms do not go away with treatment.

  • Your PEG tube is longer than it was when it was put in.

  • You have questions or concerns about your PEG tube, formula, or medicine.

Seek care immediately or call 911 if:

  • You feel sick to your stomach, vomit, or your abdomen is swollen and painful.

  • You have blood coming from your PEG tube, the stoma, or your anus.

  • You have sudden abdominal pain and dizziness.

  • Your PEG tube is shorter than it was when it was put in.

  • Your PEG tube comes out.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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