POSITION STATEMENT
The Role of the Nurse/Associate in the
Placement of Percutaneous Endoscopic Gastrostomy (PEG) Tube
Disclaimer
The Society of Gastroenterology Nurses and Associates, Inc. (SGNA) assumes no responsibility for the practices or recommendations of any member or other practitioner, or for the policies and procedures of any practice setting. Nurses and associates function within the limitations of licensure, state nurse practice act, and/or institutional policy.
Definitions
For the purpose of this document, SGNA has adopted the following definitions:
Percutaneous endoscopic gastrostomy (PEG) tube placement refers to an endoscopic technique for placing a gastrostomy/jejunostomy tube for enteral feeding.
Nurse refers to registered nurse (RN), licensed practical nurse (LPN), or licensed vocational nurse (LVN).
Associate refers to unlicensed assistive personnel such as technicians, technologists, and assistants.
Background
Percutaneous endoscopic gastrostomy (PEG) was first introduced in 1980 (Gauderer, Ponsky & Izant, 1980) as an alternative to laparotomy for surgical placement of feeding tubes (American Society for Gastrointestinal Endoscopy [ASGE], 2003). PEG tube placement has profoundly impacted nutritional management, particularly in adult patients unable to maintain sufficient oral intake, and has become worldwide standard for direct gastric access (Dumortier et al., 2004; Society of American Gastrointestinal Endoscopic Surgeons [SAGES], 1988). Traditionally two physicians have performed the procedure. Recent studies with adult patients have shown the efficacy of training an experienced gastroenterology nurse to assist with PEG tube placement (Patrick, Kirby, McMillion, DeLegge, & Boyle, 1996; Wilson, 1999).
Position
SGNA supports the position that the registered nurse educated and experienced in gastroenterology nursing and endoscopy can be given the responsibility for performing an expanded role in the presence of and under the direct supervision of a physician endoscopist. The RN is required to maintain current knowledge, competency and experience in PEG tube placement to fill this role. This knowledge should include, but is not limited to:
1. Anatomy of stomach and abdomen;
2. Sterile technique;
3. Preparation of a patient's abdomen;
4. Manipulation of endoscope;
5. Digital indentation of the stomach;
6. Infiltration of the patient's abdomen with local anesthetic;
7. Incision technique(s);
8. Trocar insertion;
9. Gastrostomy tube insertion;
10. Gastrostomy tube traction for proper positioning;
11. Indications and contraindications; and
12. Potential complications.
Care of the patient undergoing a PEG tube placement includes a minimum of three distinct and separate patient care roles (excluding the endoscopist):
1. An RN providing direct nursing care to the patient, including, but not limited to: administration of medication as ordered; continuous assessment and intervention as necessary; maintaining a patent airway; monitoring tolerance of the procedure; and documenting care.
2. An RN assisting with the PEG tube placement, providing technical assistance to the physician/endoscopist by either:
a. Maintaining position of the endoscope; manipulating controls as directed; insufflating of viscera; and snaring the wire/thread; or
b. Preparing the abdomen; local infiltration; incision; trocar placement; threading the wire/thread; and positioning gastrostomy tube.
3. An RN, LPN/LVN or associate providing technical support to the physician endoscopist and RNs.
References
American Society for Gastrointestinal Endoscopy. (2003). Role of endoscopy in enteral feeding. Gastrointestinal Endoscopy, 55(7), 794-797.
Dumortier, J., Lapalus, M. G., Pereira, A., Lagarrigue, J. P., Chavaillon, A., & Ponchon, T. (2004). Unsedated transnasal PEG placement. Gastrointestinal Endoscopy, 59(1), 54-57.
Gauderer, M. W. L., Ponsky, J. L., & Izant, R. J. Jr. (1980). Gastrostomy without laparotomy: A percutaneous endoscopic technique. Journal of Pediatric Surgery 15, 872.
Patrick, P. G., Kirby, D. E., McMillion, D. B., DeLegge, M. H., & Boyle, R. M. (1996). Evaluation of the safety of nurse-assisted percutaneous endoscopic gastrostomy. Gastroenterology Nursing, 19(5), 176-180.
Society of American Gastrointestinal Endoscopic Surgeons. (1988). Role of percutaneous endoscopic gastrostomy. [Guideline]. Santa Monica, CA: Author.
Wilson, L. (1999). Nurse-assisted PEG in pediatric patients. Gastroenterology Nursing, 23(3), 121-124.
Recommended Reading
American Society for Gastrointestinal Endoscopy. (2003). Role of PEG and PEJ in enteral feeding. Gastrointestinal Endoscopy, 48(6), 699-701.
Angus, F., & Burakoff, R. (2003). The percutaneous endoscopic gastrostomy tube: Medical and ethical issues in placement. American Journal of Gastroenterology, 98(2), 272-277.
Gauderer, M. W. L., Ponsky, J. L., & Izant, R. J. Jr. (1998). Gastrostomy without laparotomy: A percutaneous endoscopic technique. Nutrition, 14(9), 736-738.
Schurink, C.A., Tuynman, H., Scholten, P., Arjaans,W., Kinkenberg-Knol,E., Meuwissen, S. et al. (2001). Percutaneous endoscopic gastrostomy: Complications and suggestions to avoid them. European Journal of Gastroenterology and Hepatology, 13(7), 819-823.
Society of Gastroenterology Nurses and Associates, Inc. (2003). Gastroenterology Nursing: A Core Curriculum (3rd ed.). Chicago: Author.
Society of Gastroenterology Nurses and Associates, Inc. (2004). Manual of Gastrointestinal Procedure (5th ed.). Chicago: Author.
Society of Gastroenterology Nurses and Associates, Inc. (2005). Role delineation of assistive personnel. [Position Statement]. Chicago: Author.
Society of Gastroenterology Nurses and Associates, Inc. (2005). Role delineation of the licensed practical/vocational nurse in gastroenterology and/or endoscopy. [Position Statement]. Chicago: Author.
Society of Gastroenterology Nurses and Associates, Inc. (2005). Role delineation of the registered nurse in a staff position in gastroenterology and/or endoscopy. [Position Statement]. Chicago: Author.
Adopted by the SGNA Board of Directors, February 1994
Revised May 2002 and October 2005
SGNA Practice Committee 2005-06
Susan Bohlander, BSN, RN, CGRN, Chairperson
Cynthia M. Friis, MEd, RN-BC
Donna Girard, BSN, RN, CGRN
Anne Scroggs, MSN, APRN-BC
LeaRae Herron-Rice, BSN, RN, CGRN
Loralee Kelsey, RN, CGRN
Carol Kraai, MSN, RN, CGRN
Lisa D. Miller, LPN, CGN
Cindy Taylor, MSA, BSN, RN, CGRN
Trina Van Guilder, BSN, RN, CGRN