To the Editor,

I would like to provide the following food for thought for my fellow gastroenterology nursing colleagues. Are we as a specialty benefiting our percutaneous endoscopic gastrostomy (PEG) patients? Although we are providing them a means of nutrition other than a nasogastric tube, are we doing anything else?

Have we really thought through our role with these patients? Are we teachers? Are we advocates? Or, are we merely a means to an end? Here is where I am coming from. I have been a gastrointestinal nurse for almost 20 years and the caretaker of a family member with a PEG, and this experience really opened my eyes to how little we truly provide to our patients with a PEG. We think that the physician's office will set them up with a home health provider who will do all the instructing and answer all the questions the family may have. Guess what? That is wrong!! The patient's family gets minimal instruction on the feedings and even less instruction on care. When my father had his PEG, he would complain of pain every time you would touch it. Of course, being a good gastrointestinal nurse, I asked my gastroenterologist, "Can this be true?" His answer was "yes"; in a small number of patients, they develop hypersensitivity at the site and have true pain when the tube is moved.

So now come the questions. How do I handle a PEG tube so as not to cause pain, especially when feeding? No one could answer my question nor could I find very much about it on the Web. So through trial and error, we learned a way to handle his tube without causing him pain. Next came the cleaning of the site-oh, was that fun!! Can you see where I am going with this? We need to be more proactive in the long-term care of our patients with PEGs.

In my department, we developed a simple instruction sheet that explains every type of feeding, how to clean the site, how to handle a clogged tube, and who to call if the patient just has a question. We give out our department number, and patients and families are told not to hesitate to call us. They are told that we are here to help in any way we can to make this a less stressful situation as possible. That is what we are here for, isn't it?

I challenge you to assess what your department is doing to help PEG patients. Maybe you can be the one to start a program to help these patients. Or, maybe you can see if there is something already known that has not been adequately incorporated into your protocol. Either way, these patients need us to truly be their advocate, teacher, and a means to an end-an end that means fewer trips to the emergency room for tube problems or to the endoscopy unit to have their PEG replaced; fewer intravenous sticks, antibiotics, times under sedation, being afraid, or feeling like a failure because they could not care for their loved one properly because of PEG tube problems. It truly is time for us to speak up.

Rose Ann Beckwith, BSN, RN, CGRN

Greater Fort Worth Regional Society, [email protected]