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PEG (Percutaneous Endoscopic Gastrostomy) Care and Management Policy

1. Purpose

At {{org_field_name}}, we are committed to delivering safe, effective, and person-centred PEG care to individuals who require enteral feeding via a Percutaneous Endoscopic Gastrostomy (PEG) tube. This policy ensures that all PEG care and management are carried out with dignity, safety, and clinical excellence, in line with CQC regulations, NICE guidelines, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and the Mental Capacity Act 2005.

Our aim is to promote safe feeding, maintain skin integrity, prevent infections, and support individuals to live as independently as possible while receiving PEG care.

2. Scope

This policy applies to all staff, including permanent, temporary, agency, and volunteer workers who provide care and support to individuals with a PEG tube in our Supported Living service. It covers PEG tube insertion, maintenance, feeding, medication administration, infection control, risk management, and emergency response procedures.

3. Related Policies

• SL12 – Safe Care and Treatment Policy
• SL07 – Person-Centred Care Policy
• SL21 – Medication Management and Administration Policy
• SL16 – Infection Prevention and Control Policy
• SL08 – Dignity and Respect Policy
• SL34 – Confidentiality and Data Protection (GDPR) Policy
• SL13 – Safeguarding Adults from Abuse and Improper Treatment Policy

4. PEG Tube Care and Management

4.1 Person-Centred PEG Care Plans

• Every individual requiring PEG feeding must have a detailed, personalised care plan.
• The care plan must be developed in collaboration with healthcare professionals, the individual, and family members (if applicable).
• The care plan should include:
  • The reason for PEG feeding (e.g., dysphagia, neurological conditions, post-surgical needs).
  • Feeding regimen (timing, type of feed, and administration method).
  • Hydration needs and fluid intake monitoring.
  • Medication administration via PEG.
  • Daily PEG site care routine.
  • Signs of complications and escalation procedures.

4.2 Feeding via PEG Tube

• Staff must follow the prescribed feeding regimen and nutritional requirements set by a dietitian or healthcare professional.
• Feeds should be administered using:
  • Gravity feeding (if prescribed) or syringe feeding.
  • Pump-assisted feeding where required.
• Before administering feeds:
  • Check tube placement by aspirating stomach contents or following prescribed verification methods.
  • Flush the tube with sterile water before and after feeding to prevent blockages.
  • Ensure the individual is positioned upright (at least 30-45 degrees) during and for at least 30 minutes after feeding to prevent aspiration.

4.3 Medication Administration via PEG

• Only liquid or crushed medications (as prescribed) should be administered via PEG.
• Flush the tube with sterile water before and after medication administration to prevent clogging.
• Never mix multiple medications together to avoid drug interactions.
• Maintain accurate medication administration records (MAR) and report any concerns to healthcare professionals.

5. Infection Prevention and PEG Site Care

5.1 Daily PEG Site Care

• Inspect the PEG insertion site daily for signs of redness, swelling, leakage, or infection.
• Clean the site with mild saline or sterile water using a clean gauze pad.
• Dry the area thoroughly to prevent moisture buildup and ensure the PEG tube is securely positioned.
• Rotate the external fixation device once daily (if applicable) to prevent skin adherence and irritation.
• Use a non-occlusive dressing if required, ensuring the area remains clean and dry.

5.2 Preventing Infection and Blockages

• Hand hygiene must be performed before and after handling the PEG tube.
• Ensure sterile equipment is used for all procedures.
• Regularly flush the tube with sterile water to prevent clogging and bacterial buildup.
• Report any unusual leakage, discolouration, or odour at the site immediately.

6. Recognising and Managing Complications

6.1 Identifying PEG Tube Complications

Staff must be trained to identify and respond to the following complications:

• Tube blockages – Difficulty flushing or administering feed.
• Leakage around the tube site – May indicate improper tube positioning or infection.
• Infection or irritation – Redness, swelling, pus, pain, or fever.
• Aspiration risk – Coughing or difficulty breathing after feeding.
• Dislodged or misplaced tube – Requires urgent medical attention.

6.2 Responding to PEG Emergencies

• If the PEG tube becomes blocked:
  • Attempt to flush with warm sterile water.
  • Do not use excessive force—contact a healthcare professional if unresolved.
• If the tube falls out:
  • Cover the site with a sterile dressing.
  • Seek urgent medical attention to prevent closure of the stoma.
• If an infection is suspected:
  • Report immediately to a GP or district nurse.
  • Follow antibiotic treatment if prescribed.

7. Risk Assessment and Safety Measures

• A PEG feeding risk assessment must be conducted and regularly updated.
• Risk assessments should cover:
  • Choking and aspiration prevention.
  • PEG site infection risks.
  • Handling and disposal of enteral feeding equipment.
  • Staff competency in PEG management.

8. Staff Training and Competency

• All staff providing PEG care must complete specialist training from healthcare professionals.
• Training includes:
  • Safe administration of PEG feeds and medications.
  • Recognising signs of infection or complications.
  • Emergency procedures for dislodged or blocked tubes.
  • Person-centred care and maintaining dignity.
• Competency assessments must be conducted annually to ensure adherence to best practices.

9. Record-Keeping and Documentation

• Staff must maintain detailed records of:
  • Daily site inspections and hygiene measures.
  • Feeding times, amounts, and tolerance.
  • Medication administration and flushing routines.
  • Any complications or concerns reported.
• Records must be stored securely and comply with GDPR and confidentiality policies (SL34).

10. Monitoring and Continuous Improvement

• Quarterly audits will ensure compliance with PEG management protocols.
• Feedback from individuals receiving PEG care and their families will be used to improve care quality.
• Lessons learned from incidents or near misses will be incorporated into training and policy updates.

11. Policy Review

This policy will be reviewed annually or sooner if required due to:

• Updates in NICE or CQC guidelines.
• Changes in best practice for PEG management.
• Feedback from staff, individuals receiving support, or healthcare professionals.

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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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