Policy Manual sample

MDT Home Health Care Agency, Inc. PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) TUBE CARE POLICY CARE OF PEG TUBE This routine care can be performed by the nurses, with wound care experience preferable. After about 10 days following insertion asepsis is not required. A physician order is required. Procedure: Must be follow up all universal/standards and infection control precautions, were gloves and use handwashing techniques. • Examine the skin for infection/irritation around the site. • Note the measuring guide number at the end of the external fixation device. • Remove the tube from the fixation device and ease away from the abdomen. • Clean the stoma site with sterile saline. • Dry the area with gauze. • Rotate the gastrostomy tube to prevent adherence to sides of the track. • Re-attach the external fixation device to the abdomen. • Attach the gastrostomy tube gently to the fixation device and position as before according to the mark/number on the tube. • Avoid use of bulky dressings PEG removal A PEG tube is removed because a patient recovers and is able to take food orally. ( patients who have the tubes placed must be able to resume their protein and caloric need by mouth prior to tube removal). Physician order is required. PEG tube removal should only be done by a trained healthcare provider. If the brand of tube has a soft internal mushroom bolster, it can be removed by pulling. This may cause some transient stinging and burning at the incision site. If it has a balloon internal bolster, the balloon is deflated and the tube is removed. There are also unique commercial PEG brands that require other methods of removal. Note: If the tube is removed accidentally, the stoma can close spontaneously within 4 hours. Patients at home must be advised to place a catheter into the opening as a space saver until a health care provider can replace the PEG properly and call the Agency immediately. Several different types of replacement tubes currently are available and can be placed without endoscopy. The two major types are a double-lumen balloon design held in place with an internal balloon and an outer retention disk, and a non-balloon tube held in place with a soft internal dome. Both have an external device to hold the PEG in place Is recommended all tubes be removed and routinely replaced at 6-month intervals. Patient’s Physician must be notified, and replacement order obtained. Although it is not necessary for the patient to be restricted from oral intake for tube removal, it is desirable; any food in the stomach will leak from the PEG site after the tube is removed. Removal of the tube depends on the brand. If the brand of tube has a soft internal mushroom bolster, it can be re - moved by pulling. The patient should be told there is some discomfort as the PEG is pulled through the abdominal wall. The tube is pulled quickly and strongly as it requires significant force to pull the bumper through the PEG tract. If it has a balloon internal bolster, the balloon bumper is deflated and the tube is removed. A dressing should be placed over the site as there will be some drainage for about 24 hours. A balloon or button gastrostomy is removed by deflating the balloon and pulling the tube from the abdomen. Purposeful removal of the PEG should not performed less than 30 days post insertion. However, patients whose tubes left greater than 1 year and then removed have a higher rate of persistent gastrocutaneous fistula. The tube should not be actively used for nutrition supplementation or Home Health Agency Nursing Care & Procedures K-225