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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 ensure the safe, effective, and person-centred care of individuals who require Percutaneous Endoscopic Gastrostomy (PEG) feeding. This policy outlines the procedures for safe administration, maintenance, and infection control related to PEG tubes, in compliance with Care Inspectorate Scotland regulations, NHS Scotland guidelines, and the Scottish Social Services Council (SSSC) Codes of Practice. Our goal is to ensure optimal nutrition, hydration, comfort, and dignity while preventing complications.

2. Scope

This policy applies to all employees, agency staff, and healthcare professionals providing care for individuals who receive PEG feeding under the support of {{org_field_name}}. It covers:

• Safe administration of PEG feeding.
• Hygiene and infection prevention measures.
• Tube maintenance and troubleshooting.
• Training and competency requirements for staff.
• Emergency procedures related to PEG tube care.

3. Related Policies

• Medication Management Policy
• Infection Prevention and Control Policy
• Health and Safety Policy
• Safeguarding Adults and Children Policy
• Risk Assessment and Management Policy
• Incident Reporting and Investigation Policy

4. Legal and Regulatory Compliance

{{org_field_name}} adheres to the following legislation and guidance:

• Care Inspectorate Scotland Standards – Ensuring safe and high-quality PEG care in domiciliary settings.
• NHS Scotland Enteral Feeding Guidelines – Best practices for PEG feeding and tube care.
• Health and Safety at Work Act 1974 – Employer’s responsibility for ensuring safe care environments.
• Scottish Social Services Council (SSSC) Codes of Practice – Guidance for professional and ethical conduct in care.
• Adults with Incapacity (Scotland) Act 2000 – Legal framework for decision-making in individuals lacking capacity.

5. Person-Centred PEG Care Planning

5.1. Individualised Care Plans

Every person requiring PEG feeding must have a personalised care plan, developed in collaboration with healthcare professionals, dietitians, families, and the individual (where possible). This plan should include:

• Type and size of PEG tube in use.
• Feeding regimen (e.g., bolus feeding, continuous pump feeding).
• Formula type, volume, and schedule prescribed by a dietitian.
• Hydration plan, including water flushes.
• Oral hygiene protocols to maintain oral health.
• Skin care and infection prevention measures.
• Emergency procedures and escalation protocols.
• Roles and responsibilities of care staff and healthcare professionals.

5.2. Risk Assessment and Monitoring

A comprehensive risk assessment must be conducted for each individual receiving PEG care, covering:

• Risk of infection at the insertion site.
• Tube displacement or blockage risks.
• Aspiration or reflux complications.
• Signs of nutritional deficiencies or overfeeding.
• Monitoring for discomfort, leakage, or granulation tissue formation.
• Positioning during and after feeding to prevent aspiration.

6. Safe Administration of PEG Feeding

6.1. Preparation Before Feeding

Staff must ensure the following before administering PEG feeds:

• Hand hygiene and use of personal protective equipment (PPE).
• Confirming correct placement of the PEG tube before feeding.
• Checking for blockages or leaks before use.
• Preparing feeds in a clean and sterile environment.
• Ensuring the individual is positioned at a 30-45 degree angle during and for at least 30 minutes after feeding.

6.2. Administering the Feed

• Bolus Feeding:
  • Administer using a syringe or gravity feeding set as prescribed.
  • Flush the tube with sterile water before and after feeding to prevent blockages.
  • Monitor for signs of intolerance, such as nausea or bloating.
• Pump Feeding:
  • Set up the feeding pump correctly and monitor for consistent flow.
  • Regularly check for signs of tube kinking, leakage, or dislodgement.
  • Ensure correct pump calibration as per manufacturer guidelines.

6.3. Hydration and Medication Administration

• Water flushes must be carried out before and after feeds to keep the tube clear.
• Only liquid medications or crushed tablets (where approved) should be administered through the tube, following medical guidance.
• Never mix medication directly with the feed to avoid interactions.

7. Infection Prevention and Tube Maintenance

7.1. Daily Cleaning and Skin Care

• Clean the PEG site daily with mild soap and water (unless advised otherwise by a healthcare professional).
• Avoid using alcohol-based products that may dry the skin.
• Monitor for redness, swelling, leakage, or unusual odour, which could indicate infection.
• Rotate the external fixator regularly to prevent pressure sores.

7.2. Preventing and Managing Tube Blockages

• Flush the tube before and after every feed or medication administration.
• Use warm water and gentle aspiration if a blockage occurs—never force the tube.
• Seek medical advice immediately if the blockage does not resolve.

8. Emergency Procedures

8.1. Tube Displacement or Accidental Removal

• Do not attempt to reinsert the tube unless trained to do so.
• Cover the stoma site with a sterile dressing.
• Contact emergency services or a healthcare professional immediately.

8.2. Signs of Infection or Complications

• Increased redness, swelling, pain, or discharge around the PEG site.
• Fever, vomiting, or unexplained discomfort.
• Leakage of feed or fluids from the site.
• Report any of the above to the nurse or healthcare professional promptly.

9. Staff Training and Competency

All care staff responsible for PEG management must complete:

• Specialist PEG training and competency assessments before undertaking PEG care.
• Annual refresher training to maintain up-to-date knowledge.
• Scenario-based practical training sessions on troubleshooting common issues.
• Ongoing supervision and competency checks by senior care staff or healthcare professionals.

10. Documentation and Incident Reporting

• All feeding, hydration, and medication administration must be recorded accurately in the individual’s care notes.
• Any tube-related incidents or complications must be logged and reported as per Incident Reporting and Investigation Policy.
• Care plans must be updated following any significant changes in feeding regimen or health status.

11. Policy Review

This policy will be reviewed annually or earlier if required due to legislative updates, Care Inspectorate guidance, or organisational needs. Any amendments will be communicated to all staff.

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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.