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Gastrostomy Care (PEG Feeding) in Residential Care Policy

People who have swallowing difficulties or who are unable to meet their nutritional requirements orally but have a functioning gut can be fed in a variety of ways by enteral feeding. This is a process whereby a nutritionally complete liquid feed is delivered directly into the stomach, duodenum or jejunum via a nasogastric, gastrostomy or jejunostomy tube. It is an important technique in combating malnutrition, which can lead to weight loss, nutritional deficiency, impaired immune functions, decrease in cognitive function, depression and delayed rehabilitation.

{{org_field_name}} understands percutaneous endoscopic gastrostomy (PEG) feeding to refer to the placing of a PEG tube through a person’s skin and into their stomach so they can be fed and given the fluids they need. The procedure requires a minor operation and is usually done after a sedative injection.

A dietician will usually decide upon the feeding regime.

When PEG feeding is used, {{org_field_name}} is aware that there are risks of bacterial contamination of the feed and gastrostomy site, which can lead to infection and associated complications. The home therefore recognises the importance of preventing contamination and infection by adhering to standard (universal) infection control precautions, which include:

• effective hand hygiene
• the wearing of appropriate protective clothing
• safe disposal of clinical waste
• decontamination of equipment and the environment
• the safe disposal of sharps.

The home is aware that research shows that poor handling of the feeding system is the main cause of bacterial contamination of sterile enteral feeds.

This policy will set the standards for practice within the home and will reflect the requirements of the National Patient Safety Agency (NPSA) and National Institute for Health and Care Excellence (NICE).

Aim

The aim of this policy is to ensure that people in {{org_field_name}} who require feeding through a PEG tube, or any other form of enteral feeding, receive high-quality, safe care at all times.

Policy

1. The decision to initiate PEG feeding is a clinical decision and should involve the person, their carers and family, and members of the multi-disciplinary team including his or her GP, speech and language therapists and dieticians. The decision will be recorded on their support plan and clinical indications for PEG feeding will be reviewed regularly to prevent unnecessary device use. All such reviews will be fully documented.
2. A person with a PEG tube will have his or her feeding regimen calculated by a dietician. No changes to a feeding regimen should be made without consulting a dietician, even to the volume of water flushes.
3. People who use the services who require PEG feeding will have regular nutritional monitoring, including his or her weight.
4. People who use the services have a fundamental legal and ethical right to determine what happens to their own bodies and valid consent to treatment should therefore be obtained before a PEG tube is inserted. Such consent should be documented as set out in the home’s Consent to Care and Treatment policy.
5. Where it is suspected that a person lacks the capacity to make an informed decision then staff should follow the home’s Mental Capacity Act policy and act in compliance with the Mental Capacity Act 2005, which provides a statutory framework to empower and protect vulnerable people who may not have the capacity to make their own decisions about specific treatments and/or care.
6. Staff should be aware that there are serious ethical and legal considerations relating to the use of enteral feeding and nutritional support may not always be appropriate. Decisions on withholding or withdrawing nutrition support therefore require a consideration of both ethical and legal principles, both at common law and statute including the Human Rights Act 1998. When such decisions are being made, best practice guidance should be followed.
7. PEG feeding should only ever be employed if clinically indicated for the health of the person concerned and never for the convenience of others.

Where PEG feeding is used as part of a care package the following applies.

1. Suitably trained, supervised and qualified members of care staff only will administer feeding via the PEG tube and will be responsible for its care, maintenance and cleanliness.
2. Administration of feeds must be signed on the prescription and administration chart by the member of staff undertaking the feeding. Staff should carefully check the prescription for feed, dosages and water flushes and measure the required amount of feed. They should assemble all the necessary equipment, check to ensure the feed matches the prescription, and ensure the feed and other equipment is within expiry date. Application of feed should follow the agreed protocol for this procedure depending on the specific equipment used.
3. A strict hand hygiene technique (using liquid soap and/or alcohol-based hand gel) must always be used before and after handling the feeding tube, feed container or giving set, etc.
4. Staff should always wear clean non-sterile examination gloves prior to any manipulation of the enteral feeding system.
5. The insertion site should be observed daily for signs of infection (ie inflammation, redness, heat and purulent discharge).
6. If signs of infection are seen a wound swab should be obtained for microbiological examination and the GP or tissue viability nurse informed.
7. Where rotation is required the tube should be rotated 360° once per week to prevent the internal disk of the gastrostomy from becoming buried in the stomach lining. Where this procedure is necessary it should be clearly specified in the support plan (jejunostomy tubes and certain types of radiologically-inserted gastrostomies must not be rotated).
8. Equipment and feeds should be opened in a clean environment and a no-touch technique should be adopted when preparing the feed during priming and connecting to the administration set/feeding tube.
9. Care staff should never leave dirty equipment in a container as feed can block tubes and allows bacteria to grow. Equipment should be rinsed with cold water, washed with warm soapy water and then rinsed again to remove all traces of soap.
10. If a PEG tube is accidentally removed or deteriorates it will need to be replaced and the person’s GP should be called.

Training

PEG feeding and routine equipment care should be performed by suitably trained, supervised and qualified members of care staff only. This includes nursing staff and designated care workers who have successfully completed additional training from a healthcare professional and have had their competence checked and recorded.

All care staff assisting with PEG feeding must have a sound understanding of infection control principles and carry out safe working practices to prevent and control infection.

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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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