Introduction

Gastrostomy placement is a method of providing nutrition to patients who are unable to eat.

Definition

 A gastrostomy is an artificial opening through the abdomen into stomach, a gastrostomy

feeding tube is then inserted through this opening into stomach.
 A PEG is a safe and effective way to provide food, liquids and medications directly into
the stomach.

Indications of gastrostomy feeding

 Swallowing disorder
 Esophageal strictures
 Gastric decompression
 Need for prolonged nutritional support
 Neurological disorders like CVA
 Head and neck cancer patients

Handling a PEG tube

A. Care before each feeding

Prior to each feeding the tube must be checked for –
 Patency (free from obstruction and leaks)
 Gastrostomy tube insertion site for redness, pain, dressing
 Check for residual stomach contents using a hand syringe to make sure patient is
absorbing food properly.
 Less than 150 ml is acceptable, if more than that withhold feeding until level goes
down.
 Give an upright position atleast 30 degree before feeding.

B. PEG feeding procedure

(i) Cleanliness
Wash hands thoroughly before preparing formula and every patient contact.
(ii) Food handling
Formula should be given at room temperature, too hot or cold would make patient
uncomfortable.

(iii) Bolous Feeding

  Never force fluids through PEG tube if bolous feeding.
 Formula may be instilled using gravity flow
 Intermittent feeding is usually two hours interval
 Infuse formula slowly to prevent abdominal cramps, nausea and vomiting,
gatric distension or diarrhea

(iv) Continuous Feeding

 Feeding pump is set up and tubing is connected to PEG tube.
 Dumping syndrome may occur
(sweating and weakness, rapid heart beat after infusion of nutrition).
 If any of these symptoms appear, feeding should be stopped and inform
physician.

(v) Medications
 Dissolve tablets in 15 ml to 30 ml water
 Following administration of any medication, tube must be flushed with water.

(vi) Tube blockage

 It may be prevented with routine practice of flushing tube after each feed.
 If blockage occurs tube should be irrigated using large bulbed syringe.
 Donot use excessive force while irrigating as the tube may rupture.
 Milking tube may dissolve obstruction.

C. Nurses responsibility after gastrostomy feeding

(i) Oral hygiene

 Daily cleaning of patient’s teeth, gum and tongue should be done.

 Patients lip should be moistened with lukewarm water , lubricate lips with petroleum
jelly to prevent cracking or drying of lips.

(ii) Aspiration

 Help patient to remain in upright position for 30 minutes after feeding to avoid risk of
aspiration and complication of pneumonia.

(iii) Observe for abdominal distension, pain, redness at PEG site, soakage of dressing, leakage of
gastric contents.
Conclusion
BIBLIOGRAPHY

 Smeltzer, Suzane C., Bare, Brenda G., Hinkle, Janice L., Cheever, Kerry H.(12th
edition)Brunner and suddarth’s, textbook of medical surgical nursing:new delhi:wolters
kluwer page no-328-331,312,313,-332.
 Shebeer P, khan, S Yaseen(2017): a concise textbook of advance nursing
practice:Banglore;emmess medical publishers.
 https://www.mayoclinic.org/diseases-conditions/cardiomyopathy/diagnosis-
treatment/drc-20370714