Where are they?
Elicia stocks the PEGs at locker at her desk, we have sizes 16fr, 18fr, 20fr
When planning a future change, please check ahead of time (~1 week) that your size does not need to be ordered (24Fr can be ordered on request).
What should I know before changing a PEG?
When was the first PEG initially placed, when and where was the current one placed?
Was it a difficult placement? was it placed by IR or surgery?
What size is the old PEG?
Is the old PEG a balloon or bumper (if unsure, check for balloon side port).
How to Bill?
Use the following codes
25 modifier (when coding for the visit)
43762 - Replacement G-tube & B4087 (gtube Standard) - this is to bill for the procedure itself and for the tube if provided by MSVD, place under "orders"
Document clearly your procedure in your note. See dotphrase below
What should you bring to change them?
The PEG
Lubricant
Empty syringe to deflate old PEG balloon
Small Syringe filled with sterile water to inflate new tube (balloons range in size from 10cc to 20cc, check your PEG packaging!)
Consent for procedure
Large catheter tip syringe to aspirate gastric contents
I also suggest bringing a Foley catheter. In case you cannot place PEG, you will need to place foley to keep stoma patent while you get help from a colleague, send them to the ER or send them to GI or IR.
How do you confirm placement?
A long-term tube does not need an X-ray to confirm if the original PEG has been in place for at least 6 weeks. Confirmation can be done at bedside with aspiration of gastric contents from the newly placed tube.
How do I change a PEG?
Watch this Helpful video:
http://www.nejm.org/doi/full/10.1056/NEJMvcm1207131
When should a PEG NOT be changed by MSVD?
Use your clinical judgment but I would advise specialist referral if the original PEG was placed surgically or was a reported technically difficult placement or if it a j-tube.
Do not blindly place a new PEG without a G-tube study (xray with gastrografin) if the stoma is less than 6 weeks old.
How should I documentation?
Use dot phrase .VDPEG
Make sure to document consent, the size PEGplaced and that you confirmed placements with GI content aspiration