In-Home PEG Replacement

The procedures such as in-home PEG replacement , PEG placement and PEG care are surgical procedures performed at home by intensive care physicians.

In-Home PEG Replacement Service is a surgical application performed with the use of a replacement tube in a home environment by the intensive care physicians assigned by home care and health services.

What is PEG? In-Home PEG Replacement

PEG (Percutaneous Endoscopic Gastrostomy) is the procedure of placing a tube into the stomach by passing through the abdominal wall in order to control the nutrition of patients who have problems with feeding and therefore cannot take food orally.

With the placement of PEG, it is ensured that the patient’s liquid or solid food needs and drug treatments reach the stomach directly through a thin tube without using the esophagus.

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In-Home PEG Replacement

The treatment protocols of in-home PEG replacement service are shaped in line with this plan and the nutrition of the patient is continued with the help of PEG.

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Which Patients Need PEG (Percutaneous Endoscopic Gastrostomy) Placement Procedure?

PEG application is applied to the patients whose feeding cannot be provided orally and who have a malnutrition condition for more than a month. Later, in-home PEG replacement and care procedures should be followed in these patients.

The PEG method, which is able to be applied to patients in need from all age groups, can be performed on a wide range of patients from newborn babies to the patients who are treated due to old age.

PEG Placement and Some Diseases That Require In-Home PEG Replacement

  • Brain and nervous system diseases
  • Confusion or loss of consciousness following a neurological disease (stroke, head injury)
  • Indigestion
  • Tumors in esophagus
  • ALS disease (Motor Neuron)
  • Myasthenia gravis
  • Tumors in the neck
  • Diseases such as dementia, Alzheimer’s, Parkinson’s
  • Congenital Anomalies
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    What Should Be Considered Following PEG Placement?

    The patients whose PEG placement procedure is performed – if there is no in-patient follow-up – may return to their environment (home) following a 6-8 hours’ follow-up period.

    The important point here is strictly complying with the nutrition plan provided by the physician/nutritionist and taking care of the location where PEG is placed in.

    During this period, receiving in-home support from an experienced nurse with intensive care experience in PEG replacement procedures through an institution that provides home care and health services will both provide the patient with comfort and relieve the concerns of the patient’s relatives.

    PEG Care Matters!

    • In patients with PEG, dressing the PEG incisions at home starts the next day of the PEG placement and sterile dressing is made every day during the first week. Dressing of the incision continues once in every 2-3 days after the wound heals.
    • In the patients having in-home PEG replacement – also depending on the healing process of the wound – the patient may be contacted with water after 10 to 14 days with a supported bathing process.
    • If there is rash and burning sensation at the PEG location but the inflammatory discharge is not visible, such condition is probably due to stomach acid. Clean around the PEG incision twice a day with saline solution.
    • Once a day, rotate the PEG cannula 360 degrees around itself and move it up and down. This procedure will be shown to you by your home care nurse.

    The Nutrition Plan of the Patient Having In-Home PEG Replacement is Important!

    • The nutrients as well as the food other than liquid mixtures can be mashed or given a custard-like consistency and delivered through the PEG.
    • Nutrients must be delivered warm. Hot foods may disrupt the structure of the tube, while cold foods may clog the tube.
    • During the administration of medications, the medicine is crushed and diluted.
    • According to the nutrition plan of the patient with a PEG, a specified amount of nutritional support is provided up to 4 to 6 meals a day.

    Regular nutrient delivery to patients having in-home PEG replacement in line with their diet also supports the proper functioning of their immune systems. In cases where PEG is not placed, the patients fail to get the daily calorie values required, therefore their immunity decreases and they become more vulnerable to diseases and infections.

    Complications Following PEG Placement and In-Home PEG Replacement

    Infection: Since daily dressings are applied in PEG care, the area where the PEG tube is placed through must be evaluated and checked by the nurse and patient’s relatives against infection. It is normal to have some rash or a whitish discharge in that area. However, if the rash is larger than 8 mm in diameter, and there is an accompanying yellowish-greenish discharge having a nasty smell, the physician must be informed immediately.

    Aspiration: There are patients suffering from pneumonia due to stomach contents going down the windpipe. In this case, wheezing, high fever, sputum, cough, and shortness of breath can be observed.

    Pain: There may be some pain depending on the procedure performed on the first day of placing the PEG catheter. Pain is relieved with the painkillers recommended by the physician.

    The strain that may occur in the abdominal muscles within a day or two may cause pain. This situation is temporary, but the physician should be informed if the pain becomes continuous.

    Sometimes, although rare, other side effects such as dehydration and salt loss due to electrolyte imbalance, edema, skin deformation, urinary disorders, fatigue or sleepiness, diarrhea, nausea, and irregular defecation, may be encountered.

    In-Home PEG Replacement | How to Unclog a Clogged PEG?

    • If nutritional products, water or medication cannot be delivered into the tube, there may be a clogging in the tube.
    • In this case, it should be checked whether the tube is bent or not.
    • Try to slide the tube between your fingers by gently squeezing out from the inlet along the length of the tube. You can repeat this process several times.
    • Try washing the tube by injecting 30-50 ml of warm water. Try to unclog the tube by moving the injector piston back and forth for a few minutes or several times.
    • If the clogging is not unclogged, wait 30 minutes and repeat the process of moving the injector piston back and forth.
    • If the clogging in the tube still persists, you should contact your physician or home care nurse.

    How is the Medication Administered Through PEG?

    • Consult with your physician or pharmacist whether the drugs to be used are suitable for crushing.
    • You should use your medicines at the recommended times and doses in accordance with empty/full stomach use.
    • Pulverize your medicines suitable for crushing in a clean mortar. Mix with 20 ml of water.
    • Stop any ongoing feeding. Before and after drug administration, prevent contact with the nutritional product by injecting 30-40 ml of water into the feeding tube.
    • If more than one drug is used, prevent the contact of drugs with each other by administering each drug separately.
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    How to Perform In-Home PEG Replacement?

    PEG tubes can last for months. However, sometimes in-home PEG replacement may be required due to the deformations that may occur in the tube over time. With the in-home PEG replacement service, the PEG tube can easily be removed and replaced with a new one by the anesthesiologist in the home environment.

    PEG incisions close shortly after the tube is removed. Therefore, special attention should be paid to unintentional dislodgements.

    The duration of PEG application may vary depending on the patient’s condition. The patient may be fed orally if the PEG is placed and the patient does not have difficulty in swallowing, if the physician grants approval.

    However, this should be done under the supervision of a physician and nurse. When the patient starts to eat normally; the tube in the stomach is removed by means of an endoscopic procedure by the intensive care physician without harming the patient.

    Approximately 2 hours following the removal of PEG catheter by the physician, normal oral nutrition can be started.

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