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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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PEG Care and Management Policy

1. Purpose

This policy outlines {{org_field_name}}’s commitment to ensuring the safe and effective care of individuals requiring Percutaneous Endoscopic Gastrostomy (PEG) feeding. It aims to establish best practices in line with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, CQC fundamental standards, and the National Institute for Health and Care Excellence (NICE) guidelines. The policy ensures that PEG feeding is conducted in a safe, person-centred, and dignified manner, maintaining the health, well-being, and quality of life of the people we support.

2. Scope This policy applies to all staff involved in the care, support, and management of people with PEG tubes, including nurses, care assistants, and other healthcare professionals working at {{org_field_name}}. It covers the entire process of PEG management, from insertion to daily care, emergency protocols, and ongoing monitoring.

3. Principles of PEG Care The following principles underpin our approach to PEG care:

• Dignity and Respect: Ensuring people feel comfortable, informed, and involved in decisions regarding their feeding and care.
• Safety and Hygiene: Maintaining strict infection control measures in line with Regulation 12 – Safe Care and Treatment.
• Person-Centred Care: Developing individualised care plans to align with preferences and medical needs.
• Competent Staff: Ensuring all staff involved in PEG care are trained and assessed for competency in handling PEG tubes safely.
• Regular Monitoring: Conducting routine checks and addressing complications promptly to prevent harm.

4. PEG Insertion and Consent

• The decision for PEG placement is made by a medical professional, in consultation with the person, their family, and the multidisciplinary team (MDT).
• Regulation 11 – Need for Consent is followed, ensuring that the person, or their legally appointed decision-maker, has given informed consent.
• A comprehensive risk assessment is carried out before PEG insertion to evaluate suitability.
• Where a person lacks capacity, the Mental Capacity Act 2005 is adhered to, with best interests considered in decision-making.

5. Daily PEG Tube Care

• Hand Hygiene: All staff must wash hands and wear gloves before handling the tube.
• Site Cleaning: The insertion site must be cleaned with sterile saline and dried to prevent infection.
• Tube Position Check: Staff must ensure the tube remains secure and in the correct position before feeding.
• Flushing: The tube must be flushed before and after feeding and medication administration to prevent blockages.
• Monitoring for Signs of Infection: Redness, swelling, pain, or leakage must be reported immediately to the nurse in charge.

6. Administering PEG Feeds

• Person-Centred Approach: Feeds must be given at a comfortable pace, respecting the individual’s preferences.
• Correct Positioning: The person should be at a 30-45 degree angle during and at least 30 minutes post-feed to prevent aspiration.
• Adhering to Dietician Guidelines: Feeds should only be administered as per the prescribed regimen by a qualified dietitian.
• Monitoring Tolerance: Staff must observe for bloating, discomfort, nausea, or vomiting and report concerns promptly.
• Documentation: Every feed given must be recorded, including type, volume, and any observations.

7. Medication Administration via PEG

• Only prescribed liquid or crushed medications (as advised by a pharmacist) should be administered via the PEG tube.
• Medications must be flushed with sterile water before and after administration to prevent interactions and blockages.
• Staff must always confirm the correct tube placement before administering medications.

8. Preventing and Managing Complications

• Blockages:
  • Regular flushing with warm water.
  • Gentle massage of the tube to clear minor blockages.
  • If unresolved, escalate to a healthcare professional.
• Infection Prevention:
  • Clean site daily with sterile techniques.
  • Use appropriate barrier creams if irritation occurs.
  • Monitor for fever, discharge, or increased pain, and report immediately.
• Dislodgement:
  • Staff must not attempt to replace a PEG tube.
  • Cover the site with a sterile dressing and seek urgent medical attention.

9. Training and Staff Competency

• All staff providing PEG care must undergo specialised training in PEG tube management.
• Competency assessments must be conducted annually or as needed.
• Only trained and authorised staff can perform PEG feeding and medication administration.

10. Record-Keeping and Documentation

• Daily Log: Staff must document all feeds, flushes, medication administration, and any concerns.
• Incident Reporting: Any adverse event, tube displacement, or infection must be reported to the Registered Manager immediately.
• Care Plans: Each person must have an updated PEG care plan, reviewed regularly with the MDT.

11. Family and People We Support Involvement

• Families and the people we support must be educated on PEG care where appropriate.
• We encourage open communication and feedback to improve care quality.
• Support groups and additional resources should be provided where needed.

12. Emergency Procedures

• Choking/Aspiration: Immediate positioning, suctioning (if trained), and calling emergency services.
• Severe Infection: Rapid escalation to GP or hospital if sepsis is suspected.
• Tube Displacement: Immediate dressing and urgent medical attention.

13. Related Policies

• CH11-Safe Care and Treatment Policy
• CH18-Risk Management and Assessment Policy
• CH21-Medication Management and Administration Policy
• CH23-Lone Working and Staff Safety Policy
• CH27-Staff Supervision, Training, and Development Policy
• CH30-Equality, Diversity, and Inclusion Policy

14. Policy Review

This policy will be reviewed annually or earlier if there are changes in CQC regulations, clinical best practices, or business needs. Updates will be made to ensure compliance with CQC standards, NICE guidelines, and emerging best practices in PEG care and management.

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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.