Care instructions for PEG tube insertion site during two phases - the first two weeks after insertion and the long term care afterwards.

In general, patient and caregiver need to do 3 types of checks daily:
1) Check the insertion site for redness or leakage
2) Check marking number to ensure correct tube position
3) Check external bumper to ensure it sits comfortably on skin

During first two weeks after insertion, patient and caregiver need to do:
1) Rotate tube 360 degrees once daily
2) Ensure gap between bumper and skin is 10mm
3) Keep tube and insertion site dry when showering by covering them with a plastic bag
4) Change the wound dressings after shower daily

Steps to change wound dressings:
1) Prepare a disposable dressing set, normal saline and tape
2) Ensure that the hands are washed with soap and water and then dried
3) Clean the wound using a cotton ball with saline and gently remove any discharge or crust
4) Dry the area with a cotton ball
5) Slide the gauze between the wound and the bumper
6) Secure the bumper with tape

After first two weeks of insertion, patient and caregiver will need to take note that:
1) Daily rotation of the tube is no longer needed
2) Gap between the skin and the tube bumper need not be so tight and one can use a finger to estimate the recommended gap of about 1 cm
3) Daily cleaning of the wound with the dressing set is no longer required
4) Shower as per normal and remember to dry the tube and site after showering

Common problems one will encounter when caring for PEG tube and the accompanying solutions:
Problem: Blockage of the tube
Solution: Use warm water to irrigate tube. Do not use soda or carbonated beverages to irrigate tube.

Problem: Hypergranuation
Solution: It’s a normal skin reaction and need not be treated unless it’s causing pain or severe bleeding.

Problems:
- Persistent leakage from the wound site
- Dislodgement of the tube, or if the tube tear
- Severe abdominal pain, especially after feeds
- Severe bleeding from the wound site
- Signs of infection such as pus from the wound, a high fever (38.5 degree Celsius or above)
- Persistent nausea, vomiting, diarrhoea, or constipation that lasts for five days or more
- Clogging of the tubes such that it can no longer be used and need to be replaced or removed
Solution: Contact your PEG nurse (during office hours) or seek immediate medical attention at the nearest A&E (after office hours)

00:00 - Introduction
00:12 - What is a PEG tube?
01:08 - General tube care
01:46 - Tube care during 1st 2 weeks after insertion
02:39 - Steps on wound dressing change
03:24 - Tube care after 1st 2 weeks from insertion
03:55 - Problems encountered during tube care & solutions

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About National University Hospital (NUH) (Singapore):
NUH is Singapore's major tertiary hospital and referral centre with over 50 medical, surgical and dental specialties. It is the only public hospital in Singapore to offer a comprehensive suite of specialist care for adults, women and children as well as paediatric kidney and liver transplant programme, in addition to kidney, liver and pancreas transplantations for adults.

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