A percutaneous endoscopic gastrostomy (PEG) tube is a feeding tube that is inserted into the stomach via a surgical incision in the abdomen (known as a stoma). A PEG may be inserted if a person is unable to safely eat and drink through their mouth (University Hospital Geelong 2015; The Hillingdon Hospitals 2018).

When caring for a client with a PEG tube in situ, you should be able to perform basic personal care of the stoma site as well as identify any red flags that require an escalation of care.

Monitoring the PEG Site

Routine care should comprise:

• Making sure that the PEG tube is properly supported and secured
• Making sure that the external flange is 2 to 5mm from skin level, and adjusting this if required
• Checking for any signs of tube migration and escalating care if necessary.

(ACI & GENCA 2015)

Performing Personal Care of the PEG Site

• The skin around the insertion site and under the plastic flange should be cleaned at least two to three times per day. Use a clean cloth and tap water. If you have any concerns about possible infection etc, escalate to your line manager.
• Start with cleaning as part of the client’s daily shower routine.
• The PEG tube should be rotated completely (360 degrees) once per day (starting three to five days after insertion). Refer to the client’s care plan instructions.
• Dressings should not be placed under the flange unless you have been instructed to do so or if there is leakage (until review by a clinician).
• Ensure the client maintains adequate oral hygiene.
• Place the clamp on the tube in a new position each day to ensure that the tube doesn’t weaken.
• Note that it’s normal for the client to experience redness, crustiness and moistness around the insertion site.
• Escalate to an appropriately qualified medical practitioner if the client is concerned about tenderness around the insertion site.

(RCHM 2018; University Hospital Geelong 2015)

How to Clean the PEG Site

1. Explain the procedure to the client and obtain consent
2. Ensure the client’s privacy and comfort
3. Perform hand hygiene
4. Gather all equipment to carry out the task (e.g. a bowl of warm water, cloth)
5. Perform hand hygiene
6. Don appropriate PPE in accordance with your organisation’s policies and procedures
7. Move the flange slightly away from the client’s skin to allow easy access for cleaning
8. Using mild soap and warm water, gently clean the skin around the tube
9. Thoroughly dry the area.

(The Hillingdon Hospitals 2018)

When to Escalate Care

The following signs and symptoms require escalation of care to an appropriately qualified medical practitioner:

• Pain or discomfort at the stoma site
• New bleeding
• Gastric fluid leak
• Skin or stoma site complications, including:
  • Excoriation or breakdown of the skin
  • Pressure injury
  • Embedded sutures
  • Infection (e.g. cellulitis, folliculitis)
• Tube displacement
• Tube deterioration
• Buried bumper syndrome
• Diarrhoea
• Constipation
• Nausea
• Vomiting
• Accidental removal of the PEG tube.

(ACI & GENCA 2015; Wilkey et al. 2015; SAGES 2019)

What to Do if the PEG Tube Falls Out

1. Stay calm and reassure the client
2. Cover the stoma with a clean gauze dressing to prevent the client’s stomach contents from leaking onto their skin or clothes.
3. Escalate to your line manager so that an appropriately trained medical practitioner can insert a new tube as soon as possible before the stoma closes.

(Wilkey et al. 2015)

Note: This article is intended as a guide only for non-clinical staff providing PEG site care to home care clients and should not replace best-practice care. Always refer first to your organisation's policies and procedures on PEG site care.

Additional Resources

• Living Well With a Stoma | Ausmed Article
• Stoma Care in the Home | Ausmed Article

References

• Agency for Clinical Innovation and the Gastroenterological Nurses College of Australia 2015, A Clinician’s Guide: Caring for People With Gastrostomy Tubes and Devices From Pre-Insertion to Ongoing Care and Removal, ACI & GENCA, viewed 11 June 2021, https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0017/251063/gastrostomy_guide-web.pdf
• The Hillingdon Hospitals 2018, Your Guide to Tube Feeding at Home, NHS Foundation Trust, viewed 15 June 2021, https://www.thh.nhs.uk/documents/_Patients/PatientLeaflets/dietetics/Your_guide_to_tube_feeding_at_home.pdf
• Royal Children’s Hospital Melbourne 2018, Percutaneous Endoscopic Gastrostomy (PEG) Tube Basic Care Guide, Royal Children’s Hospital Melbourne, viewed 11 June 2021, https://www.rch.org.au/uploadedFiles/Main/Content/gastro/PEG%20Basic%20care%20guide%20PDF.pdf
• University Hospital Geelong 2015, Percutaneous Endoscopic Gastrostomy (PEG) Tube Basic Care Guide, Barwon Health, viewed 11 June 2021, https://www.barwonhealth.org.au/images/downloads/health_practitioners/outpatient_services/Stomal_Therapy/PEG%20tube%20care.pdf
• Wilkey, R, Ryles, J, Oxley, D & Peck, M 2015, Percutaneous Endoscopic Gastrostomy (PEG)/Enteral Tube Care Policy, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, viewed 11 June 2021, https://www.dbth.nhs.uk/wp-content/uploads/2017/07/PAT-T-16-v-4-PEG-Enteral-Tube-Care-Policy-Final.pdf