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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:

Gastroenterology (GI) Registered Nurse refers to Advanced Practice Registered Nurse (APRN) and Registered Nurse (RN).

Licensed Practical/Vocational nurse refers to Licensed Practical Nurse (LPN) and Licensed Vocational nurse (LVN).

Nursing Assistive Personnel (NAP) refers to individuals who are trained to function in an assistive role in the gastroenterology setting.

Percutaneous endoscopic gastrostomy (PEG) tube placement refers to an endoscopic technique for placing a gastrostomy tube for enteral feeding.

Percutaneous endoscopic jejunostomy (PEJ) tube placement refers to an endoscopic technique for placing a jejunostomy tube for enteral feeding.

Background

Percutaneous endoscopic gastrostomy (PEG) was first introduced in 1980 (Slater, 2009; 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 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], 2003). Historically, two physicians have performed the procedure. Studies have shown the efficacy of training an experienced gastroenterology nurse to assist with PEG tube placement (Slater, 2009; Verschuur, Kuipers, and Siersema, 2007; Patrick, Kirby, McMillion, DeLegge, & Boyle, 1996; Wilson, 2000). Some patients cannot tolerate gastric feedings: therefore, PEJ tubes may be placed. The role of the GI RN is the same for PEG and PEJ tube placement.

Position

SGNA supports the position that the GI Registered Nurse educated and experienced in gastroenterology nursing and endoscopy can be given the responsibility for performing an expanded role if it falls within the scope of their state nurse practice act and institutional policy. This role would be performed in the presence of and under the direct supervision of a physician endoscopist. The GI RN is required to maintain current knowledge, competency and experience in PEG/PEJ tube placement to fill this role. This competency should include, but is not limited to:

  1. Indications and contraindications,
  2. Potential complications,
  3. Anatomy of stomach and abdomen,
  4. Sterile technique,
  5. Preparation of a patient's abdomen,
  6. Manipulation of endoscope,
  7. Digital indentation of the stomach,
  8. Injection of local anesthetic into the patient’s abdomen,
  9. Incision technique(s),
  10. Trocar insertion,
  11. Gastrostomy tube insertion,
  12. Gastrostomy tube traction for proper positioning,
  13. Jejunostomy tube insertion

SGNA also supports the position that there are three distinct and separate procedure roles (excluding the endoscopist) that occur during the placement of a PEG/PEJ tube.

  1. Direct patient care role
    1. This role may be performed by a GI RN or physician.
      This includes but is not limited to:
      1. administering medication as ordered,
      2. continually assessing and intervening as necessary,
      3. maintaining a patent airway,
      4. monitoring tolerance of the procedure,
      5.  documenting care.
  2. RN expanded role
    1. ‚ÄčThis role may be performed by a GI RN in the expanded role or a second physician.
      This includes but is not limited to providing assistance to the physician/endoscopist by either:
      1. Maintaining position of the endoscope; manipulating controls as directed; insufflating of viscera; and snaring the wire/thread
      2. Preparing the abdomen; injecting local anesthetic; making the incision; placing the trocar; threading the wire/thread; and positioning gastrostomy/jejunostomy tube.
  3. Technical support role
    1. This role may be performed by a GI RN, LPN/LVN or NAP. ‚Äč
      This includes but is not limited to providing technical support to the physician endoscopist and RNs.

.Healthcare workers must be familiar with the manufacturer’s recommendations for using these devices safely and effectively.

 

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.

Slater, R. (2009). Percutaneous endoscopic gastrostomy feeding: indications and management. British Journal of Nursing, 18(17), 1036-1043.

Society of American Gastrointestinal Endoscopic Surgeons. (2003). Role of percutaneous endoscopic gastrostomy. [Guideline]. Santa Monica, CA: Author.

Verschuur, E. M. L., Kuipers, E.J., Siersema, P.D. (2007). Nurses working in GI and endoscopic practice: a review. Gastrointestinal Endoscopy, 65(3), 469-479.

Wilson, L. (2000). Nurse-assisted PEG in pediatric patients. Gastroenterology Nursing, 23(3), 121-124.

Recommended Reading

American Society for Gastrointestinal Endoscopy. (2010). Enteral nutrition access devices. Gastrointestinal Endoscopy, 72(2), 236-248.

Best, C. (2009). Percutanous endoscopic gastostomy feeding in the adult patient. British Journal of Nursing, 18(12), 724-729.

Chaves, D.M., Kumar, A., Lera, M.E., Maluf, F., Artifon, E.L., Moura, E.G., et al. (2008). EUS- guided percutaneous endoscopic gastrostomy for enteral feeding tube placement. Gastrointestinal endoscopy, 68(6), 1168-1172.

Gauderer, M. W. L., Ponsky, J. L., & Izant, R. J. Jr. (1990). Gastrostomy without laparotomy: A percutaneous endoscopic technique. Journal of Pediatric Surgery, 15(6), 872-875.

Schulenberg, E., Schule, S., & Lehnert, T. (2010). Emergency surgery for complications related to percutaneous endoscopic gastrostomy. Endoscopy, 42, 872-874.

Todd, V., VanRosendaal, G., Duregon, K., & Verhoef, M. (2005). Percutaneous endoscopic gastrostomy (PEG): the role and perspective of nurses. Journal of Clinical Nursing, 14, 187-194.

Society of Gastroenterology Nurses and Associates, Inc. (2008). Gastroenterology Nursing: A Core Curriculum (4th ). Chicago: Author.

Society of Gastroenterology Nurses and Associates, Inc. (2009). Manual of Gastrointestinal Procedure (6th ed.). Chicago: Author.

Society of Gastroenterology Nurses and Associates, Inc. (2010). Role delineation of assistive personnel. [Position Statement]. Chicago: Author.

Society of Gastroenterology Nurses and Associates, Inc. (2010). Role delineation of the licensed practical/vocational nurse in gastroenterology and/or endoscopy. [Position Statement]. Chicago: Author.

Society of Gastroenterology Nurses and Associates, Inc. (2010). Role delineation of the registered nurse in a staff position in gastroenterology and/or endoscopy. [Position Statement]. Chicago: Author.

Approved by the SGNA Board of Directors, February 1994, 2002, 2005 & 2008. Revised 2012.

Contributors

SGNA Practice Committee 2011 – 12
Michelle E. Day MSN BSN RN CGRN Chair
Michelle Juan MSN ACNS-BC RN CGRN Co Chair
Kathy Buffington BSN RN CGRN
Rhonda L. Casey RN BS MHA CGRN
Cynthia M. Friis MEd BSN RN-BC
Ann Herrin, BSN RN CGRN
Colleen Kelley Keith MSN RN CGRN
Judy Lindsay MA BSN RN CGRN
Marilee Schmelzer PhD RN
Barbara Zuccala MSN RN CGRN

 
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