DC91-PEG Care and Management

Registration Number: {{org_field_registration_no}}

PEG Care and Management

1. Purpose and Commitment

The purpose of this policy is to outline how {{org_field_name}} ensures the safe, effective, and compassionate care for service users with Percutaneous Endoscopic Gastrostomy (PEG) feeding tubes. PEG feeding is a method used to deliver nutrition, hydration, and medication directly into the stomach through a tube. This policy ensures that all staff involved in PEG care follow best practices, maintain hygiene standards, and promote the well-being of service users.

Our commitment is to provide person-centred care that upholds the dignity, safety, and health of service users requiring PEG feeding. This policy aligns with the Health and Social Care Act 2008, NICE guidelines, and the Care Quality Commission (CQC) standards. It also ensures that staff are competent, confident, and supported in delivering PEG care while respecting the preferences and rights of service users.

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.
Rotating the tube daily to prevent tissue adherence.
Applying barrier creams as needed to protect the skin.

6.2 Infection Prevention Staff must:

Use personal protective equipment (PPE) during PEG care.
Maintain a sterile environment when handling the feeding tube.
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.
Flushing the tube with sterile water before and after feeds to prevent blockages.

7.2 Medication Administration When administering medication via PEG:

Only liquid formulations or crushed tablets (as prescribed) should be used.
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.
In case of tube displacement, do not attempt reinsertion; seek immediate medical attention.
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:

Accredited PEG care training.
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.
Contact emergency services if the tube is dislodged, if there are signs of infection, aspiration, or gastrointestinal complications.
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

This policy is reviewed annually or following any significant incident. Compliance is monitored through:

Regular audits of PEG care practices and documentation.
Staff feedback and incident reports.
Investigations following reported complications or concerns.
Updating care plans and practices based on new guidelines and findings.

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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