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Registration Number: {{org_field_registration_no}}

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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:

• Ensure that all PEG-fed service users receive safe and effective nutrition and hydration.
• Provide clear training and competency requirements for staff managing PEG feeding.
• Outline infection prevention and control measures to minimise risks.
• Establish a robust monitoring and reporting system to detect and respond to complications promptly.

2. Scope

This policy applies to:

• All employees who are responsible for caring for PEG-fed service users, including nurses, care assistants, and senior carers.
• All service users requiring PEG feeding, ensuring their nutritional and hydration needs are met safely and effectively.
• Healthcare professionals, including dietitians, GPs, and speech and language therapists (SALT), involved in PEG care planning.
• Family members and advocates, ensuring they are kept informed and involved in care decisions.

This policy covers:

• PEG tube insertion and maintenance.
• Safe administration of feeds, fluids, and medications.
• Prevention and management of complications.
• Staff training and competency assessments.
• Person-centred care and dignity considerations.

3. Legal and Regulatory Framework

This policy aligns with:

• The Regulation and Inspection of Social Care (Wales) Act 2016.
• The Social Services and Well-being (Wales) Act 2014, promoting person-centred care and dignity.
• CIW regulatory requirements regarding safe care, nutrition, and hydration.
• The Health and Safety at Work Act 1974, ensuring a safe working environment for PEG care.
• NICE Guidelines for Enteral Feeding (NG163).
• The Nursing and Midwifery Council (NMC) Code, ensuring professional accountability in PEG management.

4. PEG Feeding Management

4.1 Assessment and Care Planning

• All service users requiring PEG feeding will have a comprehensive care plan, developed in collaboration with:
  • Dietitians, who assess nutritional needs and prescribe feeds.
  • Speech and Language Therapists (SALT), where swallowing risks need monitoring.
  • GPs or hospital specialists, overseeing medical considerations.
• The care plan must include:
  • Type and size of PEG tube.
  • Feeding schedule (e.g., continuous or bolus feeding).
  • Formula type and volume.
  • Flush protocol to maintain tube patency.
  • Monitoring requirements for weight, hydration, and bowel function.
  • Signs of infection or complications.

4.2 Administration of Feeds

• PEG feeds must only be administered by trained staff, who follow the prescribed feeding regimen.
• The correct formula must be checked against the care plan before each feed.
• Before administering a feed:
  • Check the tube position to prevent aspiration.
  • Ensure the tube is flushed with sterile water (as per care plan).
  • Observe for any leakage, redness, or discomfort.
• During feeding:
  • Keep the service user in an upright position (30-45°) to prevent aspiration.
  • Administer feeds at the prescribed rate, avoiding rapid delivery.
  • Monitor for signs of intolerance, such as vomiting, bloating, or diarrhoea.
• After feeding:
  • Flush the tube with 30-50ml of sterile water to prevent blockages.
  • Keep the service user upright for at least 30 minutes post-feed.

4.3 Medication via PEG

• Only liquid medications should be used, unless the prescribing pharmacist confirms that tablets can be crushed.
• Each medication must be administered separately, flushing with sterile water before and after each dose.
• Never mix medications with feeds, as this can cause tube blockages or medication interactions.

4.4 Tube Care and Hygiene

• PEG tube sites must be cleaned daily with warm water and dried thoroughly.
• The area must be checked for redness, swelling, or leakage.
• Staff must wear gloves and aprons when handling PEG tubes.
• The external fixation device should be rotated daily to prevent buried bumper syndrome.

4.5 Monitoring for Complications

Staff must immediately report and document any of the following:

• Tube displacement – If the PEG tube falls out, emergency medical assistance must be sought immediately.
• Blockages – If the tube becomes blocked, attempt flushing with warm water. If unsuccessful, refer to the GP or hospital.
• Infections – Look for redness, pain, swelling, discharge, or fever.
• Gastrointestinal issues, such as vomiting, bloating, or diarrhoea.

4.6 Infection Prevention and Control

• Staff must use strict hand hygiene before and after handling PEG equipment.
• Equipment, including syringes and feeding sets, must be changed as per manufacturer guidelines.
• Feeding solutions must be stored and prepared hygienically to prevent bacterial contamination.

4.7 Person-Centred Care and Dignity

• Service users must be involved in all decisions regarding their PEG feeding.
• Ensure privacy and dignity when providing PEG care.
• Offer alternative food options for taste stimulation (if appropriate).
• Encourage social interaction during mealtimes, even if oral intake is limited.

5. Training and Staff Competency

• All staff managing PEG feeds must receive specialist training, including:
  • Administering PEG feeds and medications.
  • Recognising and responding to complications.
  • Safe hygiene and infection control practices.
• Competency assessments are conducted annually.
• New staff must complete PEG training before handling PEG tubes.

6. Record-Keeping and Documentation

• Every PEG feed must be documented, including:
  • Type and amount of feed given.
  • Time of administration.
  • Any adverse reactions or complications.
  • Tube site condition.
• Medication administration via PEG must be recorded in the MAR (Medication Administration Record).
• Any changes to the feeding plan must be signed off by a dietitian or healthcare professional.

7. Related Policies

This policy must be read alongside:

• Safe Care and Treatment Policy.
• Meeting Nutritional and Hydration Needs Policy.
• Medication Management and Administration Policy.
• Infection Prevention and Control Policy.
• Risk Management and Assessment Policy.

8. Policy Review

This policy will be reviewed annually or sooner if regulatory changes, best practices, or operational needs change. Regular audits and staff feedback will ensure its effectiveness.

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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}}
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