Registration Number: {{org_field_registration_no}}

PEG Care and Management Policy

1. Purpose and Commitment

The purpose of this policy is to set out how {{org_field_name}} supports service users who require Percutaneous Endoscopic Gastrostomy (PEG) feeding and related care. PEG feeding provides a direct route into the stomach for the administration of nutrition, hydration and, where prescribed, medication.

{{org_field_name}} is committed to ensuring that PEG care is delivered safely, effectively and in a person-centred manner. Staff must follow each service user’s individual care plan, clinical instructions and agreed risk-management arrangements when providing PEG-related support.

Our approach is designed to:

Protect the health, safety and well-being of service users.
Maintain appropriate standards of hygiene and infection prevention.
Ensure nutrition, hydration and medication are administered safely and in accordance with the care plan.
Identify and respond promptly to signs of complications.
Promote dignity, choice, independence and involvement in care decisions.
Ensure staff undertaking PEG-related tasks are appropriately trained, assessed as competent and supported in their role.

This policy sets out arrangements intended to support the provider’s duties under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including Regulations 9 and 12, and current CQC and NICE guidance relevant to PEG care.

2. Scope

This policy applies to all employees, including care staff, administrative staff, volunteers, and contractors involved in PEG care. It covers:

PEG tube insertion (understanding but not performing insertion).
Daily care and maintenance of the PEG site.
Safe administration of nutrition, hydration, and medication.
Monitoring for complications and responding appropriately.

The policy applies to all domiciliary care settings where service users require PEG feeding as part of their care plan. It ensures that the care delivered aligns with individual needs and preferences while promoting dignity and independence.

3. Policy Statement

{{org_field_name}} is committed to ensuring safe and effective PEG care through comprehensive staff training, adherence to clinical guidelines, and continuous monitoring. We aim to promote service users’ independence while ensuring their nutritional and medical needs are met safely. Our approach includes:

Regular risk assessments and care plan reviews.
Effective communication with healthcare professionals and families.
Prompt action in case of complications.
Encouraging service user involvement in their own care where possible.

4. Understanding PEG Feeding

4.1 What is PEG Feeding? PEG feeding involves the insertion of a tube through the abdominal wall into the stomach, providing a direct route for nutrition, hydration, and medication. It is typically used for individuals who cannot eat or drink safely due to medical conditions such as stroke, neurological disorders, or cancer. PEG feeding can be temporary or long-term, depending on the service user’s condition.

4.2 Indications for PEG Feeding PEG feeding may be indicated for:

Dysphagia (difficulty swallowing).
Neurological conditions affecting swallowing, such as multiple sclerosis or Parkinson’s disease.
Severe malnutrition or inability to maintain adequate oral intake.
Conditions requiring long-term enteral feeding, including certain cancers and gastrointestinal disorders.

PEG feeding provides a safe and effective way to maintain nutrition and hydration while reducing the risk of aspiration pneumonia and malnutrition.

5. Roles and Responsibilities

5.1 Care Staff Responsibilities All staff involved in PEG care must:

Complete PEG care training, including competency assessments.
Follow individualised care plans for each service user.
Adhere to infection prevention and control protocols.
Monitor for complications and report concerns immediately.
Maintain accurate documentation of care provided.
Support service users and families in understanding PEG care procedures.

5.2 Manager Responsibilities Managers are responsible for:

Ensuring staff receive appropriate training and supervision.
Conducting regular audits of PEG care practices.
Reviewing care plans and risk assessments regularly.
Addressing any issues identified during audits or staff feedback.

5.3 Service User and Family Responsibilities Service users and families are encouraged to:

Participate in care planning and decision-making.
Report any concerns or changes in health promptly.
Follow hygiene and safety practices related to PEG care at home.

6. PEG Site Care and Hygiene

6.1 Daily Site Care To prevent infection and ensure comfort, daily site care includes:

Washing hands thoroughly before and after care.
Cleaning the stoma site with warm water and gauze.
Checking for redness, swelling, or discharge.
Rotate a gastrostomy tube only where the individual’s care plan and the tube manufacturer’s instructions require it, at the stated frequency; do not rotate a tube with a jejunal extension unless specifically directed by the specialist team.
Applying barrier creams as needed to protect the skin.

6.2 Infection Prevention Staff must:

Use personal protective equipment following an assessment of exposure risk and the applicable standard infection-control precautions.
Use the hand-hygiene and aseptic or no-touch technique specified in the individual’s care plan, current guidance and the equipment manufacturer’s instructions.
Dispose of waste according to infection control guidelines.
Monitor for early signs of infection and take appropriate action.

7. Administration of Nutrition, Hydration, and Medication

7.1 Feeding Procedures PEG feeding must follow the care plan, including:

Verifying tube placement before each feed by checking external tube length and observing for signs of displacement.
Using prescribed enteral feeds at the correct temperature.
Administering feeds slowly to prevent discomfort, bloating, or reflux.
Flush the tube before and after feeds using the volume and type of water specified in the individual’s care plan and current clinical guidance, taking account of immune status and tube position.

7.2 Medication Administration When administering medication via PEG:

Use only a formulation and preparation method confirmed as suitable for the individual medicine and tube by the prescriber, pharmacist or authorised medicines plan; never crush a tablet or open a capsule without specific confirmation that this is safe.
Each medication should be administered separately, with flushing between doses.
Staff must document all medication administration accurately.
Ensure medications are compatible with enteral feeding and do not interact negatively with feeds.

8. Monitoring and Managing Complications

8.1 Common Complications Staff must be vigilant for:

Infection: Redness, swelling, or discharge at the stoma site.
Blockage: Difficulty flushing the tube or resistance during feeding.
Displacement: Tube movement or dislodgement.
Gastrointestinal Issues: Nausea, vomiting, or diarrhoea.
Granulation Tissue: Excess tissue growth around the stoma site.

8.2 Responding to Complications

For minor issues, follow the care plan and consult healthcare professionals as needed.
If the tube appears displaced or is dislodged, stop feeds and medicines, do not attempt reinsertion unless specifically trained and authorised for that device, and follow the individual’s urgent escalation plan because the tract can begin to close quickly.
Document all observations and actions taken.
Communicate with healthcare providers for ongoing management.

9. Training and Competency

9.1 Staff Training All staff involved in PEG care must complete:

Task-specific PEG care training matched to the person’s tube, feed regimen, equipment and care plan.
Regular refresher courses to maintain up-to-date knowledge.
Competency assessments conducted by qualified trainers.

9.2 Competency Checks Managers will conduct regular competency checks, including:

Observing PEG care procedures.
Reviewing documentation practices.
Providing feedback and additional training if needed.
Ensuring staff remain confident and competent in PEG management.

10. Record-Keeping and Documentation

Accurate record-keeping is essential for safe PEG care. Staff must document:

Daily site care and observations, including stoma condition.
Feeding times, amounts, and tolerance.
Medication administration, including dose, time, and method.
Any complications or concerns, including actions taken and outcomes.

11. Communication and Collaboration

Effective communication ensures continuity of care. This includes:

Regular updates to healthcare providers, including GPs and dietitians.
Collaboration with dietitians and pharmacists to optimise nutrition and medication management.
Clear communication with service users and families, ensuring they understand PEG care processes and can report concerns promptly.
Multidisciplinary team meetings to discuss complex cases and review care plans.

12. Emergency Procedures

In case of an emergency, staff must:

Stay calm and ensure the service user’s safety.
Follow the individual’s urgent escalation plan and seek emergency assistance for breathing difficulty, suspected aspiration, severe pain, significant bleeding, acute deterioration or any other emergency; obtain urgent specialist advice for a dislodged or displaced tube.
Follow the service user’s emergency care plan and document all actions taken.
Provide reassurance to the service user and family while awaiting medical assistance.

13. Compliance and Review

{{org_field_name}} will monitor compliance with this policy to ensure that PEG care continues to be delivered safely, consistently and in accordance with individual care plans and agreed clinical instructions.

Compliance will be monitored through:

Regular audits of PEG care practices and associated documentation.
Review of care plans, risk assessments and PEG-related records.
Staff competency assessments, supervision and training records.
Review of incidents, complications, near misses and concerns.
Feedback from staff, service users, families and healthcare professionals where appropriate.
Review of actions identified following audits or investigations to ensure they have been completed and are effective.

This policy will be reviewed at least annually and sooner where there is a significant incident, change in legislation, regulatory requirement, clinical guidance or organisational practice that may affect PEG care.

Where a review identifies changes to practice, these will be communicated to relevant staff and reflected in care plans, risk assessments, training or competency assessments as appropriate.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

DC91-PEG Care and Management