per cutaneous endoscopic gastrostomy
TRANSCRIPT
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.