Users are strongly advised to review with their MD, noting any differences in protocols/procedures, prior to taking any actions recommended by this chart. The chart is intended as a helpful reference, and should not replace the advice of your MD.  Users of PEG feeding systems should read the entire chart, (at least briefly,) comparing symptoms listed in each section with those actually experienced by the patient, before taking action.

Nausea/Vomiting*

Symptoms:

  • Nausea, vomiting
  • Abdominal distress, distention, feeling bloated, cramping.
  • Dry heaves/retching, cold sweat.

Immediate Action:

  • Stop feeding.
  • As per MD instruction, drain gastric contents through G-tube into a drainage bag/container or using a large syringe. If there is no return, flush with 10 cc water to make sure the tube is not blocked. Some tubes have valves (such as buttons) which make drainage difficult. If unable to vent button, call MD.
  • If vomiting persists, call MD for appropriate intervention to avoid dehydration/fluid or electrolyte depletion (see Rare Complications #3 “Fluid/Electrolyte Depletion”).

Causes:

  1. Formula intolerance:
    1. High administration rate
    2. High formula concentration, allergy/intolerance of formula components
    3. Formula contaminated
  2. Mechanical problems:
    1. Tube displaced (Improper tube placement; tube migration)
    2. Patient improperly positioned feeding
  3. Side effect of medication or other treatments such as chemotherapy
  4. GI dysfunction:
    1. Poor gastric emptying, reflux, ulcer
    2. Bowel obstruction
    3. Constipation
  5. Psycho-social stressors:
    1. Anxiety concerning tube feeding procedure
    2. Offensive odors, sight and smell of food
  6. Coughing, post nasal drip, upper respiratory infection, sore throat
  7. Intolerance to oral diet (ie. High sugar, lactose content)

Prevention:

  1. A.  When feeding, build up rate and volume slowly. If nauseas develops, decrease rate of HEN feeding until nausea subsides; gradually increase rate, then volume to previous level as tolerated, as per MD instruction.
    • Discuss with MD the possibility of switching formulas
    • Use good hand washing and clean technique when handling HEN formula/equipment. Wash all equipment with hot water after each use. It is generally recommended to use 1 bag for feedings within a 24 to 48 hour period. Before reusing, thoroughly clean bags with warm water and place in a clean container in fridge to retard bacterial growth. Do not store or wash equipment in the bathroom. Check expiration date of formula. Inspect can for bulging/evidence of contamination before opening. Cover and store any open formula in refrigerator and discard after 24 hours. Maximum hang time for formula at room temp. is 8 to 12 hours. If possible hand cold formula to slow bacterial growth.
  1. A.   Examine tube for possible migration or dislodgment (See Complication #4                              “Tube Displacement”).
    • Elevate head of bed or sit up with feedings. Position self onto right side after feedings.
  1. When starting new medications, check with MD if nausea/vomiting is a possible side effect. If MD prescribes anti-emetics, take at least 30-60 minutes prior to PEG feedings.
  2.   A.   Take dysmotility/antireflux/ulcer medications as prescribed.
    • If bowel obstruction is suspected, seek medical attention.
    • See Complication #7 “Constipation”

5.         A.  Use stress reduction/relaxation techniques/antianxiety medication prior to PEG feedings. See out support/encouragement.
B.    Remove offensive sights/smells (bedpan/commode/smell of cooking/food aversion)
6.   Notify MD of persistent cough/nasal drip/infection/sore throat for evaluation.
7.        Review oral diet with RD to see if it contains elements that lead to nausea/vomiting.
*Early morning nausea/vomiting can be common when first starting tube feeds as the body adjusts to feeding overnight and walking with a “full stomach”

Diarrhea
Symptoms
*Abdominal pain or cramping with frequent loose watery stool (color may vary)

Immediate Action:

  • Decrease volume/administration rate of PEG formula.
  • Call MD if diarrhea is excessive (a noticeable increase in watery bowel movements for 24+ hours) to avoid fluid/electrolyte depletion (see rare complications #3)
  • Call MD immediately if there is evidence of bleeding or if you are experiencing severe abdominal pain.

Causes:

  1. Formula intolerance:
    1. High administration rate
    2. High formula concentration, allergy/intolerance of formula components
    3. Formula contaminated
  1. GI Dysfunction:
    1. Short bowel syndrome
    2. Gastric Intestinal Colonization
    3. Bowel inflammation
  2. Advance side effects of medications, especially antibiotics
  3. Intolerance to oral diet (i.e. high sugar, lactose content)\

Prevention:

  1. A. Use the appropriate feeding method (bolus, gravity or pump). Build up feeding rate and volume slowly until you reach the prescribed rate. If diarrhea develops, decrease the rate of HEN feeding until diarrhea subsides; gradually increase rate, then volume to the previous level as tolerated, as per MD instruction.

B. Discuss with MD the possibility of switching formula (such as to one with fiber), and the possible need for pancreatic enzyme replacement or lactase enzyme.
C. Use clean technique when handling and storing PEG formula/equipment. (see #1 Nausea/Vomiting-Prevention 1C)
2.   A. Discuss with MD the possible use of H2 blockers or bowel slowing medication.
B. Report to MD any recent course of antibiotics. A stool culture may be needed.
C. Seek MD input to controlling bowel inflammation.
3.    Evaluate prescribed medications with RPh for possible sorbitol, magnesium, or phosphorus content. Take proper amount of medication as prescribed. Inform MD of any over the counter medications, herbals or supplements you may be taking.
4.    Review oral diet (if any) with