How To Clean Peg Tube Build Up

This information will aid yous get set up for your procedure to have a percutaneous endoscopic gastrostomy (PEG) feeding tube or a percutaneous endoscopic jejunostomy (PEJ) feeding tube placed at Memorial Sloan Kettering (MSK).

A PEG is a feeding tube that is placed into your stomach (see Figure i, left). If the tube tin can't exist placed into your stomach, you lot may take a PEJ tube placed instead (see Effigy i, right). A PEJ tube is placed in your jejunum, which is the second function of your small-scale intestine. The tube is placed during an endoscopy (a procedure that lets your medico run across within your tummy and small intestine).

Figure 1. PEG tube placement (left) and PEJ tube placement (left) — Figure 1. PEG tube placement (left) and PEJ tube placement (right)

The feeding tube will give you nutrients if y'all're not able to get enough through eating and drinking. If you're able to swallow, you tin can continue to exercise so after the PEG or PEJ tube is placed. You will employ the tube to give yourself plenty nutrition to meet your needs.

If you demand long-term nutrition support, your doc may convert your PEG into a low-profile gastrostomy button into your stomach (see Effigy 2). Your doctor may catechumen your PEJ into a low-profile jejunostomy push into your small intestine. With both of these buttons, you lot will attach the feeding adapter to get nutrition.

Figure ii. Low-profile gastrostomy button

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i Week Before Your Process

Enquire about your medications

You may need to cease taking some of your medications before your process. We have included some common examples below.

If you accept medication to sparse your blood, inquire the dr. who prescribes information technology for you when to stop taking information technology. Some examples are warfarin (Coumadin^®), dalteparin (Fragmin^®), heparin, tinzaparin (Innohep^®), enoxaparin (Lovenox^®), clopidogrel (Plavix^®), and cilostazol (Pletal^®).
If you take insulin or other medications for diabetes, you may need to change the dose. Ask the medico who prescribes your diabetes medication what y'all should exercise the morning of your process.

Get a letter of the alphabet from your doctor, if needed

If y'all have an automatic implantable cardioverter-defibrillator (AICD), you lot volition need to get a clearance letter from your cardiologist (heart doctor) before your process.

Arrange for someone to take y'all habitation

You must take a responsible care partner accept you lot habitation after your process. A responsible care partner is someone who can aid y'all get abode safely. They should exist able to contact your care team if they have whatever concerns. Make sure to programme this before the day of your procedure.

If y'all don't accept a responsible care partner to take you home, phone call i of the agencies below. They'll send someone to go dwelling house with you. There's ofttimes a accuse for this service, and y'all'll demand to provide transportation. It'south OK to use a taxi or automobile service, but you still demand a responsible care partner with you.

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3 Days Before Your Process

You volition get a telephone call from a nurse in the Endoscopy Prep Lab. The nurse volition review these instructions with you and ask you lot questions most your medical history. The nurse will besides review your medications and tell y'all which to take the morning of your procedure.

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The Twenty-four hour period Before Your Procedure

A staff member from the Admitting Office volition call you lot subsequently 2:00 p.chiliad. the day before your procedure. They will tell you lot what time you should get in at the hospital for your procedure. If you're scheduled for your process on a Monday, you volition exist chosen on the Fri earlier. If you don't receive a call past seven:00 p.g., call 212-639-5014.

If you need to cancel your process for whatsoever reason, call the doctor who scheduled it for you.

Instructions for eating and drinking earlier your surgery

Practise not eat anything afterwards midnight the nighttime earlier your surgery. This includes hard candy and gum.
Between midnight and up until ii hours before your scheduled arrival time, you may drink a full of 12 ounces of h2o (run into figure).
Starting 2 hours before your scheduled arrival time, do not eat or drink annihilation. This includes water.

The Mean solar day of Your Procedure

Things to remember

Accept the medications you lot were instructed to take the morning of your procedure with a few sips of water.
Don't put on any lotion, cream, pulverization, deodorant, brand-up, cologne, or perfume.
Remove all jewelry, including body piercings.
Leave all valuables such every bit credit cards and jewelry at home.
If you wear contacts wear your spectacles instead.

What to bring with yous

A list of the medications you take at home, including patches and creams.
Medications for breathing bug (such every bit inhalers), medications for breast hurting, or both.
A example for your glasses or contacts.
Your Wellness Care Proxy form, if yous have completed ane.

Where to park

MSK's parking garage is located on East 66^th Street between York and Start Avenues. If you take questions most prices, phone call 212- 639-2338.

To accomplish the garage, turn onto Due east 66^thursday Street from York Artery. The garage is located about a quarter of a block in from York Avenue, on the right-hand (n) side of the street. At that place is a pedestrian tunnel that you can walk through that connects the garage to the hospital.

At that place are likewise other garages located on E 69^th Street between First and Second Avenues, East 67^th Street between York and Outset Avenues, and East 65^th Street betwixt First and Second Avenues.

Where to become

Your procedure volition take place in the Endoscopy Suite at the chief infirmary which is located at:

1275 York Artery (betwixt Due east 67^th and East 68^thursday Streets)
New York, NY 10065

Take the M lift to the 2^nd flooring and go to the Surgical Day Infirmary entrance.

What to look

Once you arrive at the infirmary, doctors, nurses, and other staff members volition inquire you lot to country and spell your name and date of birth many times. This is for your rubber. People with the same or similar name may be having procedures on the same day.

Your doctor volition explain the process to y'all and respond whatsoever questions y'all may take. They will ask y'all to sign a consent form (a form that says you concord to the procedures and understand the risks).

When it's time for your procedure, you will exist brought into the procedure room and helped onto an test table. You lot will be attached to equipment to monitor your heart rate, breathing, and claret pressure level. Yous will also receive oxygen through your olfactory organ. Your nurse will identify a mouth guard over your teeth to protect them.

Yous will receive anesthesia (medication to brand you sleepy) through your 4. Once you're asleep, your doctor volition pass the endoscope (a tube with a camera on it) through your rima oris, down your esophagus (nutrient pipe), into your stomach, and into the first part of your small intestine. Your doctor volition check your tum and small intestine before placing your PEG or PEJ tube.

Your doc will make a tiny incision (surgical cutting) on the peel of your abdominal (belly) wall and pass a feeding tube through the incision. The feeding tube volition come up out about 8 to 12 inches (20 to xxx centimeters) outside your body and will exist covered past a pocket-sized dressing (bandage) to keep it in place. When your doctor has finished the process, they will take out the endoscope. Your doctor will take out the endoscope once they're done with the procedure.

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After Your Procedure

In the hospital

You lot will exist taken to the Post Anesthesia Intendance Unit (PACU), where your nurse will monitor your temperature, heart rate, animate, and blood pressure. They will also check the bandage around your tube. Yous volition stay in the PACU until you lot're fully awake.

When you're fully awake, your nutrition nurse practitioner (NP) will show you lot and your caregiver how to requite yourself the feedings and care for your PEG or PEJ tube. It's very important to have your caregiver with you during the instruction session. You'll likewise receive a resources that explains how to give yourself feedings with your PEG or PEJ tube.

Your nutrition NP will get over possible side effects that you lot may experience with your feeding tube and will requite you the Abode Parenteral Nutrition (HPN) Complication Chart as a reference. This nautical chart provides guidelines on how to treat possible complications. You can view the chart online at www.mskcc.org/pe/hpn_chart. Call your medico or NP if you lot're having any problems.

You will also receive supplies for your feeding tube for the first few days earlier you get out the hospital. Later on that, your nurse will explain how you can social club these from the visitor. The supplies include:

Supplies for dressing modify:
- 4 x 4 gauze
- Tape or Cath-Secure^®
- Zinc oxide (Desitin^®) ointment
- Iodine (Betadine^®) swab sticks
Syringe for flushing your tube with water

At home

Yous may experience some soreness in your throat. This is normal and will become better in 1 or 2 days.
You may take some discomfort at your incision site for the start 24 to 48 hours. If and then, take your hurting medication as instructed.
You can shower 48 hours after your procedure. Don't accept tub baths or go pond for 2 weeks after your procedure.
You lot may see night green or yellow drainage around your PEG or PEJ site. A small corporeality of greenish or yellow drainage is normal.

Caring for the Pare Around Your PEG or PEJ Tube

You will demand to care for the skin around your PEG or PEJ tube. Follow the steps beneath.

Check your skin

Check the pare around your feeding tube every solar day. Look for any redness, swelling, or pus. Tell your doctor or NP if you're having any of these symptoms.

Follow these instructions for the first 2 days after your process.

Remove the old dressing.
Clean the skin around the tube with iodine swab sticks in one case a solar day.
Apply zinc oxide ointment.
Cover the incision site with a 4 10 4 gauze.
Loop the tube (see Figure 4) and secure it with tape or use a Cath-Secure tab to concord it in place.

Figure 4. Looping the tube — Effigy iv. Looping the tube

Check your skin in the shower

On the tertiary day afterwards your procedure, begin a daily routine of caring for the skin around your tube while showering.

Before y'all shower, remove the old dressing around your tube.
Launder the area with soap and h2o for at least 20 seconds. Gently pat it dry.
After y'all go out of the shower, apply zinc oxide ointment.
Comprehend your insertion site with a 4 x 4 gauze pad.
Loop the tube and secure it with tape or with a Cath-Secure tab.

To protect your skin from your PEG or PEJ bumper, utilise zinc oxide and gauze.

To protect your peel from secretions, alter the dressing whenever it gets wet.

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Flushing Your Tube or Button

Flushing your PEG or PEJ tube

Flush your PEG or PEJ tube once a solar day or as directed past your doctor.

Gather your supplies:
- threescore mL syringe, either one with catheter tip or an ENFit syringe
- 60 mL of water (room temperature or warm, plain tap water) in a cup
- Newspaper towels
Wash your hands with warm h2o and soap for at to the lowest degree 20 seconds or utilise a hand sanitizer.
Pull up 60 mL of h2o into the syringe.
Place the paper towels under the Y-port at the end of the tube to absorb any drainage.
Clamp the tube.
Insert the syringe into the Y-port of the PEG or PEJ tube.
Unclamp the tube and gently push the plunger to inject the water.
Re-clench the tube.
Remove the syringe from the Y-Port of the PEG or PEJ tube.
You can reuse your syringe. Rinse information technology in warm water and dry out it with make clean paper towels after each fourth dimension y'all flush your tube.

If you're having trouble flushing your tube, call your md or nurse.

Flushing your gastrostomy or jejunostomy button

Affluent your gastrostomy or jejunostomy button in one case a day or every bit directed by your medico.

Gather your supplies:
- 60 mL syringe, either one with catheter tip or an ENFit syringe
- 60 mL of h2o (room temperature or warm, plain tap water), in a cup
- Feeding tube adapter
Wash your easily with warm water and lather for at to the lowest degree twenty seconds or use a hand sanitizer.
Pull upward lx mL of water into the syringe.
Prime the adapter with water and then clamp it.
Connect the adapter to your gastrostomy or jejunostomy push button.
Insert the syringe into the Y-port of the adapter.
Unclamp the adapter and gently push button the plunger to push in the h2o.
Re-clamp the adapter.
Remove the syringe from the Y-port of your adapter.
Disconnect the adapter from your gastrostomy or jejunostomy push.
You can reuse your syringe. Rinse information technology in warm water and dry it with clean paper towels afterwards each time your flush your button.

If y'all're having problem flushing your button, phone call your doctor or nurse.

Call Your Doctor or NP if You Have:

A fever of 100.iv° F (38° C) or higher
Chest pain or shortness of jiff
Severe abdominal (belly) pain
Diarrhea (loose or watery bowel movements)
Nausea (feeling like you lot're going to throw up) or airsickness (throwing up)
Any dizziness or weakness
Haemorrhage that doesn't terminate
Pain at your incision site that doesn't get ameliorate with medication
Problem flushing your PEG or PEJ tube or button
Drainage around your insertion site that soaks v or more gauze pads per twenty-four hours
Any sign of redness, swelling, or pus around the tube

Source: https://www.mskcc.org/cancer-care/patient-education/peg-pej-tube-feeding

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