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CHW91-PEG Care and Management Policy

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PEG Care and Management Policy

1. Purpose

The purpose of this policy is to establish clear guidelines for the safe and effective management of Percutaneous Endoscopic Gastrostomy (PEG) feeding at {{org_field_name}}. This ensures that all service users requiring PEG feeding receive appropriate, person-centred care in line with CIW regulations, The Regulation and Inspection of Social Care (Wales) Act 2016​, and best practices in clinical care.

This policy aims to:

2. Scope

This policy applies to all staff who are involved in the care and support of individuals who receive nutrition, hydration or medicines through a Percutaneous Endoscopic Gastrostomy (PEG) tube or other gastrostomy feeding device.

This includes:

Where family members, representatives or advocates are involved in the individual’s care, they will be involved in accordance with the individual’s wishes, consent, mental capacity and legal authority.

This policy covers:

Insertion, replacement or reinsertion of a PEG or gastrostomy tube must only be undertaken by a healthcare professional, or another person, who is specifically authorised, appropriately trained and competent to undertake that procedure in accordance with the individual’s clinical plan and the requirements applicable to the particular device. Care staff must not attempt to insert or reinsert a displaced tube unless this forms part of an expressly authorised healthcare procedure for which they have been trained and assessed as competent.

3. Legal and Regulatory Framework

This policy must be implemented in accordance with applicable legislation, statutory guidance and professional guidance, including:

Where there is any conflict between this policy and an individual’s current clinical instructions or specialist healthcare plan, staff must stop and obtain advice from an appropriate healthcare professional before proceeding. This policy does not authorise staff to act outside their role, competence or an individual’s prescribed clinical plan.

4. PEG Feeding Management

4.1 Assessment, Personal Planning and Review

Before staff provide PEG or gastrostomy care, the individual’s assessed needs and the arrangements for enteral feeding must be incorporated into the individual’s personal plan and relevant clinical documentation.

The personal plan and associated enteral-feeding documentation must clearly identify, as applicable:

For individuals beginning to receive the service, the provider assessment and personal plan must be completed and reviewed within the timescales required by the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended.

The individual’s personal plan must be reviewed at least every three months and sooner where required, including following a significant change in health, nutritional status, tube type, feeding regimen, swallowing ability, medicines, identified risks or professional advice.

Changes to a prescribed enteral-feeding regimen must only be made on the instruction of an appropriately qualified healthcare professional.

4.2 Administration of Feeds and Fluids

PEG or gastrostomy feeds and prescribed fluids may only be administered by staff who have received appropriate training, have been assessed as competent for the activity they are undertaking and are authorised to undertake it.

Before each feed, staff must:

Staff must not use an improvised method to test the position of a gastrostomy tube. If displacement is suspected, or the tube’s external appearance or position differs from that documented for the individual, feeding, fluids and medicines must be withheld and appropriate clinical advice obtained before the tube is used.

During feeding, staff must:

The tube must be flushed before and after feeding and at any other prescribed intervals using the volume and type of water specified in the individual’s feeding plan.

In accordance with current infection prevention guidance:

Where the individual has a fluid restriction, renal impairment or another condition affecting fluid management, staff must follow the individually prescribed flushing volume and must not apply a standard flushing volume.

Following feeding, staff must maintain the individual’s position for the period specified in their personal plan or clinical instructions and must record the feed, fluids and any relevant observations.

4.3 Administration of Medicines Through a PEG or Gastrostomy Tube

Medicines must only be administered through a PEG or gastrostomy tube where this route has been authorised and there are clear instructions for administration.

Staff must not assume that a liquid medicine is suitable for administration through a feeding tube. The formulation, route, compatibility with the tube and feed, timing in relation to feeding, dilution requirements and flushing requirements must be confirmed through the prescriber, supplying pharmacist or other appropriately qualified healthcare professional.

Tablets or capsules must not be crushed, opened, dissolved or otherwise altered unless an appropriately qualified prescriber or pharmacist has confirmed that this is safe and appropriate for that specific medicine and the authorised instruction is recorded.

Modified-release, enteric-coated, cytotoxic, hormonal or other medicines for which alteration may present a risk must not be crushed or opened unless specific professional advice authorises the proposed method of administration.

Unless specific professional instructions state otherwise:

Where administration of medication through a PEG or gastrostomy tube is delegated to a care worker, the activity may only be undertaken where:

Any uncertainty about a medicine, formulation, tube route, interaction, crushing, opening, dilution, feeding interval or flushing requirement must be referred to the prescriber or pharmacist before administration.

4.4 Tube Site Care, Device Care and Hygiene

The gastrostomy site must be inspected and cared for in accordance with the individual’s clinical plan, the type and age of the device, specialist enteral-feeding advice and the manufacturer’s instructions.

For an established gastrostomy site, routine care will include:

Gloves and other personal protective equipment must be used in accordance with the nature of the task, infection risk assessment and the service’s infection prevention and control policy.

Staff must not automatically rotate or advance every PEG or gastrostomy device.

Rotation, advancement and manipulation of the tube or external fixation device must only be undertaken where this is appropriate for the particular device and stage of healing and is expressly required by the individual’s specialist enteral-feeding instructions or manufacturer’s guidance.

Newly inserted tubes, replacement devices, low-profile devices and tubes incorporating a jejunal extension may require different care. Staff must follow the device-specific instructions and must seek specialist advice if they are uncertain about whether the device should be rotated, advanced or otherwise manipulated.

4.5 Recognition and Management of Complications

Staff must act promptly if a PEG or gastrostomy complication is identified or suspected.

Suspected displacement or a tube that has fallen out

If a PEG or gastrostomy tube becomes displaced or falls out:

Blocked tube

If the tube becomes blocked:

Suspected infection or site complication

Staff must report and escalate signs including:

Feeding intolerance or aspiration

Feeding must be stopped and appropriate clinical assessment sought where an individual develops significant vomiting, regurgitation, abdominal pain, abdominal distension, breathing difficulty, coughing or choking associated with feeding, suspected aspiration or another significant deterioration.

All complications, action taken and professional advice received must be documented in the individual’s records and escalated through the service’s incident, safeguarding and regulatory notification procedures where the relevant thresholds are met.

4.6 Infection Prevention and Control

Staff must follow the service’s Infection Prevention and Control Policy and current national infection prevention guidance when managing enteral feeding.

Staff must:

4.7 Person-Centred Care, Oral Intake and Dignity

Individuals must be supported to participate in decisions about their PEG or gastrostomy care to the greatest extent possible.

Staff must:

PEG feeding must not automatically prevent an individual from participating in mealtimes and social activities.

However, food, drink, oral medicines, ice, sweets or other oral taste stimulation must only be offered where this is consistent with the individual’s current swallowing assessment and personal plan. Where the individual has dysphagia or an identified aspiration risk, staff must follow the recommendations of the Speech and Language Therapist and other relevant healthcare professionals.

4.8 Clinical Delegation and Limits of Staff Practice

PEG and gastrostomy-related activities that constitute delegated healthcare activities must only be undertaken within an agreed governance and delegation arrangement.

The service provider must ensure that:

A registered professional who delegates an activity remains responsible for delegation in accordance with their professional standards. Staff receiving delegated activities remain responsible for working within their own competence and following the agreed instructions.

5. Training and Staff Competency

Staff must not independently undertake PEG or gastrostomy feeding, tube care, flushing or administration of medicines through the tube until they have received training appropriate to the activity and have been assessed as competent.

Training and competency assessment must be appropriate to the staff member’s role and the PEG or gastrostomy activities they are authorised to undertake.

Training must include, where relevant:

Competency must be demonstrated through an appropriate assessment of knowledge and practical ability before the staff member undertakes the activity without direct supervision.

Competency must subsequently be reviewed:

Staff must immediately inform their manager and must not undertake an activity without appropriate support where they do not feel competent or confident to perform it safely.

The service must maintain records of PEG or gastrostomy training, competency assessment, reassessment and any restrictions placed upon an individual staff member’s practice.

Where a registered nurse delegates an activity, delegation must be undertaken in accordance with the NMC Code and relevant professional standards. Where a healthcare professional delegates an activity to a care worker, the agreed responsibilities, training, competency requirements, monitoring arrangements and limits of delegation must be clear and recorded.

6. Record-Keeping and Documentation

All PEG and gastrostomy care must be documented accurately, contemporaneously and in accordance with the service’s Record-Keeping Policy.

Records of feeding and hydration must include, as applicable:

Medicines administered through a PEG or gastrostomy tube must be recorded on the Medication Administration Record and in accordance with the service’s Medication Management and Administration Policy.

Where a medicine is withheld, omitted or cannot be administered through the tube, the reason and action taken must be recorded and escalated in accordance with the medication policy.

Records must also be maintained of:

Changes to a prescribed feeding, flushing or medication regimen must only be implemented following appropriate clinical authorisation. The updated instruction must be documented and communicated to relevant staff without delay.

Records relating to individuals must be accurate, up to date, secure, accessible to authorised persons and retained in accordance with Regulation 59 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, and the service’s Record-Keeping Policy.

7. Related Policies

This policy must be read and implemented alongside the following policies and procedures, where applicable:

8. Policy Review

This policy will be reviewed at least annually and sooner where required.

An earlier review must take place where:

The service provider will ensure that any required amendments are implemented promptly, communicated to relevant staff and incorporated into training or competency assessment where necessary.

Audits of PEG and gastrostomy care, documentation, medicines administration and staff competency will form part of the service’s arrangements for monitoring the quality and safety of care.

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.

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