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PURPOSE: Percutaneous endoscopic gastrostomy (PEG) an endoscopic medical

procedure in which a tube (PEG tube) is passed into a patient's stomach through the
abdominal wall, most commonly to provide a means of feeding when oral intake is not
adequate. This provides enteral nutrition (making use of the natural digestion process of
the gastrointestinal tract) despite bypassing the mouth; enteral nutrition is generally
preferable to parenteral nutrition
Correct amount of feeding solution
60 ml catheter-tip syringe
Emesis basin
Clean gloves
pH strip or meter
Large syringe or calibrated plastic feeding bag with label and tubing
Measuring container from which to pour the feeding
Water at room temperature (60 ml or less)
Feeding pump as required


1. Assess: Your need to assess the patient to
For any clinical signs of malnutrition or identify any possible problems or
dehydration complication may occur.
For allergies to any food in the feedings
For the presence of bowel sounds.
2. Determine: To determine what type of feeding is
Type, amount, and frequency of feedings appropriate for the patient need.
Tolerance of previous feedings
3. Assemble equipment and supplies For organize work place and easy
access of the equipment you will be
4. Assist client to a fowlers position in bed, or a For the relaxing of the abdominal
sitting position in a chair. muscle and allowing for improve
5. Introduce yourself and verify the clients identity This is a patient right to know all the
and explain the procedure. procedure that will be doing into her/his
body. To achieved trust between the
patient and nurse.
6. Perform hand hygiene and other appropriate To prevent spread of microorganism.
infection control procedure.
7. Provide client privacy To give respect to the patient and
8. Assess tube placement. Allow 1 hour to elapse before testing
Attach the syringe to the open end of the tube and
aspirate. Check the pH
9. If the tube was placed in the stomach, aspirate If 100ml is withdraw, check with the
all contents and measure the amount before nurse in charge or refer to agency
administering the feeding. policy before proceeding.
10. If the client is on the continuous feeding, check every 4-6 hours or according to
the gastric residual protocol.
11. Administer the feeding Check the expiration date
Warm the feeding to room
Feeding Bag (Open System)
12. Hang the labeled bag from an infusion pole. About 30 cm (12 inches) above
Clamp the tubing, and add the formula to the the tubes point of insertion into
bag, open the clamp and run the formula the client
through the tubing than reclamp. Adjusting the clamp to the drop
factor on the bag, if not placed
on a pump.

Attach the bag to the feeding tube, and regulate To deliver the feeding over the
the drip. desired length of time or attach
to a feeding pump
Syringe (Open System)
13. Remove the plunger from the syringe and Raise or lower the syringe to adjust the
connect the syringe to a pinched or clamped flow as needed. Pinch or clamp the
nasogastric tube. tubing to stop the flow for a minute, if
the client experiences discomfort
Add the feeding to the syringe barrel
Permit the feeding to flow in slowly at the
prescribed rate.
Prefilled Bottle with Drip Chamber (Closed System)
14. Remove the screw-on cap from the container, Squeeze the drip chamber to
and attach the administered set with the drip 1/3 to capacity
chamber and tubing.
Close the clamp, hang the container on a about 30 cm (12 inches)
intravenous pole
Squeeze the drip chamber, opening the tubing
clamp and run the formula through the tubing
and reclamp.
Attach the feeding set tubing to the feeding tube To deliver the feeding over the
and regulate the drip rate. desired length of time or attach
to a feeding pump
If another bottle is not to be hung immediately, flush the
feeding tube immediately.
15. Instill 50- 60 ml of water through the feeding Drained from neck of a syringe or from
tube or medication port. the tubing of an administration port.
Add water before the feeding solution has
16. Clamp the feeding tube Clamp the feeding tube before all of
the water is instilled.
17. Ensure client comfort and safety Secure the tubing to the client
Ask the client to remain sitting
upright in fowlers position or in
a slightly elevated right lateral
position for at least 30 mins.
18. Dispose of equipment appropriately If the equipment is to be reused,
wash it thoroughly with soap
and water
Change equipment every 24
19. Document all relevant information Document the amount, kind of
solution taken , duration, and
assessment of the client.
Record the volume of feeding
and water administered on the
clients input and output record.
20. Monitor the client for possible complications Carefully assess client receiving
tube feeding for problems.