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PEG Care and Management Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides safe, effective, and person-centred care for service users with Percutaneous Endoscopic Gastrostomy (PEG) feeding tubes. PEG feeding is essential for individuals who cannot consume food orally due to medical conditions, and it requires specialist knowledge, training, and strict hygiene procedures to prevent complications such as infections, blockages, and aspiration pneumonia.

This policy ensures compliance with:

• The Regulation and Inspection of Social Care (Wales) Act 2016 – Requires providers to maintain safe and effective clinical procedures.
• The Social Services and Well-being (Wales) Act 2014 – Promotes a person-centred approach to health and care services.
• Care Inspectorate Wales (CIW) Regulations – Mandates safe management of enteral feeding in domiciliary care settings.
• The Health and Safety at Work Act 1974 – Ensures safe working conditions and infection prevention.
• The Mental Capacity Act 2005 – Provides legal guidance on decision-making for service users who may lack capacity.
• The Food Safety Act 1990 – Regulates food hygiene and safety in care settings, including enteral feeding.

2. Scope

This policy applies to:

• All employees, including care workers, nurses, and managers who provide PEG care.
• Service users receiving PEG feeding and their families.
• Healthcare professionals and external agencies involved in PEG care planning.

It covers:

• PEG feeding procedures and best practices.
• Staff training and competency requirements.
• Infection control and hygiene standards.
• Emergency procedures for PEG-related complications.
• Monitoring, documentation, and service user support.

3. What is PEG Feeding?

Percutaneous Endoscopic Gastrostomy (PEG) feeding is a method of providing nutritional support directly into the stomach through a surgically placed tube. It is used for individuals with:

• Neurological conditions (e.g., stroke, cerebral palsy, motor neurone disease).
• Swallowing difficulties (dysphagia).
• Conditions requiring long-term enteral feeding.

4. Staff Roles and Responsibilities

4.1 Responsibilities of the Registered Manager

• Ensure all care staff are fully trained and competent in PEG care.
• Conduct risk assessments for service users receiving PEG feeding.
• Ensure PEG feeding procedures align with CIW guidelines.
• Monitor staff performance and provide ongoing supervision.

4.2 Responsibilities of Care Workers

• Follow PEG care plans and feeding schedules precisely.
• Maintain strict hygiene and infection control practices.
• Monitor service user’s response to feeding and report concerns.
• Accurately document feeding times, volumes, and any complications.
• Report PEG tube issues (e.g., leakage, blockages, skin irritation) immediately.

4.3 Responsibilities of Healthcare Professionals

• Assess service users for PEG feeding suitability.
• Provide initial training and competency assessments for care staff.
• Review PEG care plans regularly.
• Respond to medical complications or changes in nutritional requirements.

5. Safe PEG Feeding Procedures

5.1 Pre-Feeding Checks

Before administering PEG feeding, care staff must:

1. Wash hands thoroughly and wear gloves.
2. Check the PEG tube position and ensure it is secure.
3. Verify the prescribed feed type and volume.
4. Check for any signs of infection or tube displacement (redness, leakage, pain).
5. Flush the tube with sterile water to prevent blockages.

5.2 Administering PEG Feeds

• Gravity or pump feeding must be administered as per service user’s care plan.
• The service user must be positioned upright (at least 45 degrees) to prevent aspiration.
• The feeding tube must be flushed before and after feeding to prevent blockages.
• Monitor the service user during feeding for signs of discomfort, nausea, or bloating.

5.3 After Feeding Care

• Leave the service user upright for at least 30 minutes after feeding.
• Clean the feeding tube site with sterile wipes and check for skin irritation.
• Record feeding details in the service user’s care notes.

6. Infection Control and Hygiene Standards

• Hand hygiene must be performed before and after PEG care.
• Single-use sterile gloves and aprons must be worn during PEG feeding.
• PEG site must be cleaned daily to prevent infections.
• All equipment must be cleaned and stored properly after each use.
• Expired feeds or contaminated equipment must be disposed of safely.

7. Monitoring and Reporting Complications

Care staff must be vigilant for common PEG-related complications, including:

7.1 Signs of Infection or Blockage

• Redness, swelling, or pus around the PEG site – May indicate an infection.
• Difficulty flushing the tube – Could be a blockage.
• Pain during feeding – Could indicate tube displacement or irritation.
• Gastrointestinal symptoms – Vomiting, diarrhoea, or bloating may indicate intolerance.

7.2 Emergency Procedures for PEG Complications

If a PEG tube falls out or becomes displaced:

1. Do not attempt to reinsert the tube – Contact emergency healthcare services.
2. Cover the site with a sterile dressing and prevent infection.
3. Contact the Registered Manager and healthcare provider immediately.

If a PEG tube is blocked:

1. Attempt to flush with warm sterile water (do not use force).
2. If unsuccessful, seek medical assistance.

If a service user shows signs of infection:

1. Clean the site and monitor symptoms.
2. Report to the Registered Manager.
3. Seek medical attention if symptoms worsen.

8. Documentation and Record-Keeping

• Daily PEG feeding logs must be maintained.
• Any complications, concerns, or changes in feeding must be recorded.
• Service user preferences and nutritional requirements must be documented in their care plan.
• All incidents must be reported and investigated in line with CIW requirements.

9. Staff Training and Competency Requirements

• Only trained and competent staff should administer PEG feeding.
• All staff must complete:
  • PEG Care and Feeding Training (practical and theoretical).
  • Annual competency assessments.
  • Infection control training.
• Supervision and mentorship are provided to new staff handling PEG care.

10. Safeguarding and Service User Rights

• Service users must be involved in their PEG care decisions where possible.
• Consent must be obtained before any PEG-related procedures.
• Best Interest Decisions (under the Mental Capacity Act) must be applied for service users unable to consent.
• Care staff must report safeguarding concerns (e.g., neglect, misuse of feeding equipment) to the Registered Manager.

11. Monitoring and Compliance

• The Registered Manager ensures compliance with CIW regulations and best practices.
• Quarterly audits are conducted to review PEG care records and procedures.
• Service user feedback is collected to ensure high-quality care delivery.
• CIW inspections will assess PEG feeding management during regulatory audits.

12. Related Policies

This policy should be read in conjunction with:

• Medication Management and Administration Policy (DCW21).
• Health and Safety at Work Policy (DCW16).
• Infection Prevention and Control Policy (DCW17).
• Risk Management and Assessment Policy (DCW18).
• Safeguarding Adults from Abuse and Improper Treatment Policy (DCW13).

13. Policy Review

This policy will be reviewed annually or sooner if required by legislative updates, CIW guidance, or operational needs.

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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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