Percutaneous Endoscopic Gastrostomy (PEG) Training

In this final section,

we'll be looking at the use of

the central feeding cheap for administrating medication,

but also for those requiring feeds via their feeding cheap.

It's important to know wherever possible medication should

be administrated in liquid or soluble form.

And although this is not always going to be possible,

so we are going to have to look at crushing certain medications.

For example,

we'll talk about how we can be sure and that

we are selecting and doing the correct thing as not to

look the tube and make sure that it's safe to give to our resident in such a way.

There's actually no absolute contraindications for using central feeding chief,

particularly when it comes to medication.

But it's important to just remember that we don't

put any medication that we think is going to

cause a risk of blockage.

And also to remember the enteric coated

or slow release medication should never be crushed

and therefore not going to be suitable for the use of an eventual feeding chair.

Yeah,

before we go on to talk a little bit more

about medication is also just important to mention around feeding,

so we'll be talking about some of the various types of feeds

and the ways that feeds can be given.

But we'll be focusing quite heavily on pumps as they are likely the

most common form of administration that you're going to see for feeding.

So you do always need to seek advice from your pharmacist before you crush.

Um, put anything down a feeding achieve. It's really important to consider.

If you've got soluble tablets,

you're gonna need to dissolve them about 10 to 15 miles of water.

Liquids ideal. If they're in a liquid form already,

shake them well. But bear in mind that some liquids are very thick, very viscous.

Think of things

um, like lateral is very sticky kind of liquid.

You might be that you need to pop a little bit of water in there.

Just you help with that going down the tube again.

Do always check with your pharmacist tablets crush and

mix them with about 10 50 mils of water.

We always check that medications are safe to crush.

If we can use an alternative route to the feeding chief, that's ideal,

so we can consider transdermal patches, injections, rectal medication,

sublingual.

Anything else that might be safe for a better

alternative from using the tube itself Should be explored.

Does not advise the board to mix different

medications together prior to the administration again,

unless advised so by a pharmacist or

medications should be prepared administrated separately.

Please do not use a 60 mil in fits renge to measure plugs when the volume of the drug

is below 10 mils because it's not going to

sufficiently accurately give you the measurement that you require.

So a 10 mil oral syringe must be used to measure drug volumes

and that unless that are 10 mils unless

and then the dose can be transferred to

the appropriate and fit syringe to be administrative.

So as I mentioned,

there's lots of guidance out there on the manipulation of medication.

The best person to be asking is your pharmacist

and, as I mentioned, ready do Consider alternative routes.

And don't forget to flush.

So you should always flush the tube prior

to giving a medication and after your medication.

It's also good practise in between medications.

So if let's say you've got several different medications to give

to give a roughly around a 10 mil flush,

sometimes it might be advisable to give a bit more

between each single medication.

Before you begin, always make sure that you've got the right syringes,

so you'll need probably a 60 million fit syringe but

also a five or 10 or 20 ft required.

And you may need some oral syringes

or 10 mill where you're preparing your medication

and you will need a tablet pressure or a mortar and pestle.

If you've got tablets that going to be administrative,

you're also going to need some freshly drawn up tap

water for your residents who are not immuno suppressed,

UM, or freshly cooled boiled water or sterile water.

Um, with a freshly open container for those who are immuno suppressed.

And it might be that you're elderly population who

are quite vulnerable may be considered to be more,

um, immuno suppressed,

and they they may. You may not consider them immune. Suppressed in the most kind of

full definition, they may be advised to be on boiled and cold water.

Always just check your dietitian. What is the safest thing to do for your resident?

It seems like the obvious thing would always

check whether your resident can take medication orally,

whether medication is necessary or whether it can be temporarily suspended,

because that in itself reduces that risk of two

blockage if you don't have to give the medication.

And of course, we're always going to wash our hands before using the cheap,

and we're gonna apply any PPE that's required.

So in this case, we should at least be wearing gloves.

So you're gonna stop the feed if there is a feed going on

and you're going to flush the tube with police 30 mils of water.

As I said,

Do you have a look to see what the dietician has a vice

so they might ask you to flush with 50 mils of water,

60 miles of water and but as a minimum should be around 30 mils.

Unless, of course, there are fluid restriction, and there's a specific reason why

we are doing less than 30. But 30 is a good rule of thumb.

There are certain medication that will interact with feed,

so you may need to consider how soon you

stop that feed prior to giving you medication.

So it maybe you need to consider that you need

to stop the feed 12 hours prior to that medication.

So some examples of things like antibiotics but also drugs

for epilepsy as well can interact with feed again.

This is something we should be checking with the pharmacist,

so you would have prepared all of your medications separately.

You'll have them ready to administrate,

please. Of course.

Never add the medication to the feed because it can cause interactions.

You're going to administrate the medication through the

tube via a 60 mil central syringe,

and you're going to make sure that that whole dose is administrated,

not forgetting to flush before and after.

If you need to administrate a medication with a volume of less than 2.5 mills,

then it's best to measure up to 10 mil syringe.

Not an end fits range but an oral syringe.

And then the plunger of a 60 mil in fits orange. Taking away so

removed that

and then, with your 10, the oral syringe,

you're going to pop that down into the barrel

of the 60 mil and fit syringe, and you're going to administrate it that way.

Once you're finished,

you can remove and dispose of any equipment that is no longer required,

and you can record what you have just done.

Dont forget.

You may need to restart the feed and bear

in mind again if there might be certain medications

where you need to wait 1 to 2 hours

between finishing the medication and restarting the feed,

moving on to home central feeding. So most of the

commercial companies that provide and the feeds they can get

those and all the equipment that goes with it.

So the feeds equipment they can get that delivered to the nursing home,

and you just need to keep in contact with them and making sure that

everything is is up today in terms of what what they should be having and

how, how much stock they have and when it needs to be renewed.

So look at central feeding using a pump.

So it's really important that whenever we're doing any kind

of feeding just to reduce the risk of aspiration,

your residents should be set up at least 30 degree angle.

The more you can sit them up the better,

and bear in mind that some people's condition will not allow that, and ideally,

you want to keep them up for at least 30 minutes.

Ideally, if you can, um, consider up to an hour afterwards again,

it just reduces that risk of aspiration.

So have them sat up.

Make sure you've got all your equipment you

require before you start your feed cheeping.

And that's really just gonna vary on the method of

feeding and and the types of feed that you're using.

Like I said, we are going to be covering a lot of feeding pumps.

But then maybe that you are giving bonuses, Um, instead,

in which case you're not going to need a giving set.

Um, if you are using a pump, you're going to need that feeding pump,

the feeding pump frame, the giving set, the cheap feed, any spare feeding tubes and,

of course, an infinite syringe.

There's a wide range of commercial feeds available,

so you've got jev itty here on the screen,

mostly because that's probably very well known brand.

But you could be using various different brands.

They do need to be prescribed, there will be prescribed by a doctor,

and it's down to the dietician who's going to decide

what kind of feed, how often

you will not need to make any decisions such as

that so it will be the dietician outside the regime.

It's the doctor that prescribes it.

You are going to be there,

administrating it in the way that has been designed for that person.

And they were looking at on the screen here, a feed that's available in liquid.

And this is very, very common, very popular choice.

You can actually get feeds in a powder form that you may need to mix up.

Feeds may contain various different additives or various different nutrients

that the dietitian may feel that they would benefit from.

Do always store them as per the manufacturer's guidelines

or instructions that will vary from feed to feed.

They do have expiry dates on them.

So it's important that you check those expiry

dates before you go ahead and administrate anything.

And, of course, if it's out of date or it looks in any way contaminated, damaged,

you wouldn't give him

feeds.

Do require shaking before you administrate them,

and they need to be at a room temperature

so you shouldn't be giving feeds that are cold.

So once you get your feet, you're going to compare it against your prescriptions.

You want to look at your Atlas and just check

that you've got the correct product in front of you.

You know, make sure the name is the same as the one that's been described.

Is this the right thing?

As I said already,

we need to check the expiry day just to make sure that it's still in date,

that it's not damaged or contaminated.

Anyway, we're going to shake the bottle before we use it,

and what we want to be doing is just looking at the appearance of the liquid.

Does it look smooth? Does it look like curdled milk?

If it is, then that's not a good sign, and we need to go back and get a different bottle.

We can't use that. It should look smooth.

No bits in it. Nice and thick, like a milkshake.

Mhm.

So once you've done your checks,

you need to then unscrew the protective cap at the top,

taking care just not to not touch the foil that

needs to stay as a non contaminated as possible.

Please don't pierce with scissors. Like I said, we want to avoid anything

really touching that foil that's not sterile,

the actual lid or the n fit giving set has a

built in for your cutter,

so it will pierce the foil automatically so you do not need to do it.

All you need to do is screw it on nice and tightly,

and it will cut the foil for you in most brands.

Almost cases again. I am really looking at Jeb Titty,

But generally speaking, most commercial brands work in a very similar way.

Albeit they might look slightly different.

Once you have got your giving set attached,

you can go ahead and hang up your container so they hang up upside down.

Gravity is going to help with pushing the feed

through so it doesn't need to be upside down and

and it will have a stand

available that we can hang it on and that is ready to be connected to the residents.

Once we ran the line through so we don't want to be giving them lots of air,

and they told me that's not going to be very nice for them.

They're going to feel very bloated,

so it's important that we run it right down to the end

of the line before we actually begin to administrate it to the president

Percutaneous Endoscopic Gastrostomy (PEG) Training

Chapters

Audio TranscriptAuto-generated