Definitions
For the purpose of this document, SGNA has adopted the following definitions:
Percutaneous endoscopic gastrostomy tube (PEG) placement is an endoscopic technique for placing a gastrostomy/jejunostomy tube for enteral feeding.
Nurse refers to registered nurse, licensed practical nurse, or licensed vocational nurse.
Associate refers to assistive personnel such as technicians, technologists, and assistants.
Background
Care of the patient undergoing a PEG placement includes a minimum of three distinct and separate patient care roles excluding the endoscopist:
1. A Registered Nurse (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 patient airway, monitoring the patient's tolerance of the procedure, and documentation.
2. An RN in an expanded role, providing technical assistance to the physician/endoscopist by
a. maintaining position of the endoscope, manipulation of controls as directed, insufflation of viscera and snaring the wire/thread.
b. preparing the abdomen, local infiltration, incision, trocar placement, threading the wire/thread and positioning of gastrostomy tube.
3. An RN, LPN/LVN, or associate providing technical support to the physician endoscopist and RN performing the expanded role. Technical support includes, but is not limited to, preparation and arrangement of instruments and supplies.
Position
The Society of Gastroenterology Nurses and Associates, Inc. supports the position that the registered nurse educated and experienced in gastroenterology nursing and endoscopy can be given the responsibility for performing the expanded role in the presence of and under the direct supervision of a physician endoscopist.
Because of the importance assigned to the task of managing the patient who is receiving sedation and analgesia, a second RN is required to assume the expanded role described above.
Education, training, and validation of competency must be provided to the RN assuming the expanded role. This instruction should include, but is not limited to, anatomy of stomach and abdomen, sterile technique, preparation of a patient's abdomen, manipulation of endoscope, digital indentation of the stomach, infiltration of the patient's abdomen with local anesthetic, incision technique(s), trocar insertion, gastrostomy tube insertion, gastrostomy tube traction for proper positioning, and potential complications and techniques to decrease complications.
References