Clamp for PEG

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tawill

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I am new to my PEG and fell at 4wks in, landed on my tummy and displaced my PEG. New tube yesterday and it doesn't have a clamp. I have lost a lot of my fine motor skills in my hands, and am having trouble trying to kink tube and refill syringe with one hand and attach syringe with one hand. Any idea where I can get a clamp that is easy to use with very little pressure one handed?
 

Diane H

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I have never had a tube with a clamp and never needed one so am puzzled by the idea of kinking or clamping the tube for syringe feedings. Do stomach contents come up and out the tube when it is open? All I get is the release of air from my stomach -- a burp! If your tube is really long, not the standard 5 or 6 inches, I suppose it could leak since it would be harder to to keep it elevated. In my 12 years with a feeding tube and in my years as a nurse, I have never been instructed to clamp or kink a tube during a syringe feeding. Clamps are used to slow feedings given slowly from an elevated bag. Perhaps you were told that it was necessary to clamp the tube to keep air out of the stomach. The open tube will not suck air in. Pressure is higher in your stomach than outside so any air flow is out, not in. Any air that gets in the tube while it is uncapped will go into your stomach when the formula is put in on top of it, but unless, and even if, you have a long tube, the amount of air is minimal. If you let a syringe empty completely before adding more formula, you will get a few more cc's of air in. Even so, it is harmless. We swallow some air when we talk, eat, and drink. Drinking through a straw gives you a straw full of air with every sip and no one ever died from that. Even my Intensive care patients didn't need to be protected from air with feedings! Sounds to me like someone is equating air through a feeding tube with air through an IV! But maybe I am missing some simple, practical use for kinking or clamping a tube. Goodness knows I have missed the obvious before!
 

4tloml

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I'm having trouble without a clamp because of medication administration. After clogging the tube, I'm following instructions to the T to give each medication separately with water flush in between. My PALS takes 12 at night and 6 in the morning. This means grinding & putting in a small lidded cup with a little water each one individually and shaking it up to dissolve. When I open the tube, it always want to spray, but probably because my PALS has just eaten (a lot). So I draw up the 60cc water to flush, then pinch the tube while I draw up first med, put it through tube, pinch tube, draw up 30 cc water to flush, then draw up 2nd med, put it through tube, water flush...12 times at night. I find it difficult to keep tube pinched with one had while I shake up, get lid off and draw up next med.

I was questioning the need to do it this way, but the IR nurse said there are some medications that will crystallize in the tube if mixed. And we (nor the nurse or pharmacy) don't know which ones they are. But a clamp on the tube would help so much!!!
 

Diane H

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Aha! That explains it. But with 18 meds to give I would just say screw it and dump them all into water at the last minute and pour them in. It is highly unlikely they would crystallize in the half a minute in the tube. If that were really a problem they would crystallize in the stomach anyway. I haven't heard of that kind of drug interaction other than some that are less effective when taken with milk. It just doesn't seem logical that you wouldn't be warned of specific drug interactions or especially that the IR nurse would be the only one to "know" that.
 

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A clamp is how peg tubes here are kept closed Diane.

I know that there are ones over there that have a cap of some kind on the end of the tube. Some people get confused when they receive a replacement with a cap on the end instead of a clamp as they feel like they should have a clamp. I also have known mobile people to blow the little cap off being active as it's interesting how much pressure can build in the stomach during activity.

4tloml go talk to your doctor about the drug interactions together and check out what can be done with what. Some medications can't be crushed either.
Having someone qualified look at the particular mix he is on and check is wise.
It sounds like a lot of medications though - sometimes a review can be a good thing as well to see if every one of those meds is applicable together.
 

Diane H

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Did some googling of drug interactions in feeding tubes. Turns out it is not the combo in the tube but the interaction with the tube feeding formula. The drugs most likely to cause problems are Dilatin and Tegretol (for seizures or possibly nerve pain), warfarin (Coumadin for blood clot prevention), fluoroquinolones (a type of antibiotic), and proton pump inhibitors (for gastric acid reduction for heartburn). The problem is usually a decrease in the amount of drug absorbed requiring dose adjustments -- or one to two hour withholding of the medication before AND after feedings. I have been on Warfarin for years, take it with my tube feeding, and since my dose is set according to my clotting time, my warfarin is already adjusted. Anyway, it isn't so much giving these meds together as giving them with the formulas which have easily absorbed and therefore quick to interact vitamins and minerals.

So, a clamp would certainly help with the process of getting the meds in and a check to see if anything he is taking would be better between feedings would narrow down the number of meds possibly needing to be given separately. I would go with a dose adjustment rather than all the feeding tube fuss! Oh, you know the extra money you may be paying for liquid form of some meds? They tend to be sticky and as or more likely to clog a tube than a well crushed pill!

Back to the original problem. Have you tried a spring type clothespin or a binder clip (as used for larger number of pages than a paper clip could hold)? Real feeding tube clamps are available on line if you want to order them.
 

tawill

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Well, maybe I am doing something wrong. Could it be because it is a new site and tube? Yes, my tube is about 5 inches long. Yes, the second I remove the cap to flush, or do a feeding, my stomach contents flow steadily out, irregardless of the level of the tube port in relation to my site. Why is this? I don't know. My first one had a clamp, so I assumed it was not unusual. It is also refered to in any Healthcare based instructions I have read. (to clamp) I can use a tubing clamp, it is just very difficult for me to unclamp it while changing/refilling syringes. I have difficulty with clothespins and anything that requires the pincher type, or scissor like motor skill. :( I am sure I will figure it out.
 

4tloml

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tawill, there are clamps available online. I've wondered how PALS manage without one--I've tried a binder clip but it's difficult with hand weakness (even my arthritis, let alone ALS).:( I hope you can find one that's easy to use.

Diane, thank you for that search. My PALS isn't taking any meds you listed, but a week after getting the tube I did try dumping a bunch together after grinding and mixing them well. Got it to what I thought was thin enough consistency (thinner than the tube formula), but when I injected it, it became a Newtonian liquid. (Remember the cornstarch "play clay" that was both solid and liquid--liquid till you squeezed it and then it became solid?) The nurse said I wasn't injecting hard enough, because the water flowed on through the tube but the medicine turned solid. UGH! Blocked it up tight. Did everything I could find recommended to unclog it (even the Coke from your site, Diane)! Visiting nurse worked on it, too. Had to go back to IR where doc got it done. So now I'm probably being overly cautious after that experience.

Tillie, I totally agree my guy needs a medicine review. I went over each med with the pharmacist before tube placement to make sure all could be crushed (and had to change a couple of meds). Going to address them again at next appointment. He has 11 (the 12th is his guafensin--much cheaper to crush a pill than buy the liquid form), but some he takes twice a day, especially since changing from extended release forms that can't be crushed. But one doc told us more than 3 is likely to lead to interactions and more than 8 is guaranteed. We understand the reason for each, but I think it's time to take away those that aren't absolutely critical.

Don't know what will be different, but tube is going to be replaced with a mic-key soon. New learning curve. :???:
 

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4tloml I'm glad that got sorted.

Diane I am a bit shocked to be honest that you would say to someone other than yourself - oh screw it and just dump a heap of meds in water at the last minute and shove into a peg. You can do what you want for yourself, but I am not surprised all that turned into goop that needed an ER to fix.

The mic key is a button that sits flat agains the skin and you attach the tube to the button and then remove, so you don't have a dangling tube. Do a google search, they are really great, far better than a dangling tube!

Tawill, there are lots of types of clamps you can get online - if the one on your previous tube was usable with your hands you may be able to buy a similar one online with a search?
 

Diane H

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Yeah, that wasn't good advice for giving 12 meds at once. I wouldn't have been surprised if it was too much gritty grindings and plugged the tube, but I was very surprised that it turned to stone! I wonder if it was actually the medication or the powder used to hold the med and form a hard tablet.

I like the Mic-Key for its lack of tubing but the adapter would be just one more aggravation for my husband! One more step in the process, one more thing to wash every time, and one more thing to lose along with the car keys. Since I am already quite a pain in the butt to him, I chose to stay with the short tube for the sake of household harmony!
 

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Cindy, the nurse is being overly risk-averse. If you post the med list here and/or consult with a pharmacist, a lot of people who have mixed meds together for oral or tube use can predict if there is really any crystal risk, and which ones go well together in a slurry. It's so much effort for that reason. Where do they all end up? In the same place! You can also do your own one-time test on any suspects in a glass with water.
 

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Personally I think, and it's JMHO, the fact the tube already clogged once requiring ER, and the fact no one here should be giving professional health advice, maybe the mixing of meds into a gloop should be overseen by professionals?

It could well be a combination of the substances holding the meds together that gave the issue.

I used to crush Chris's separately, but he did only take a couple of things, then line them up and flush, pour each one through and flush again.
 

gooseberry

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Steve was on multiple things. They advised that oral/liquid meds were better than crushing pills. They were concerned about multiple things going down sequentially even with a 60cc flush between. I think that most docs or nurses advising on this use their experience for recommendations. I am not sure there is a go to protocol.
 

Diane H

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I was questioning the need to do it this way, but the IR nurse said there are some medications that will crystallize in the tube if mixed. And we (nor the nurse or pharmacy) don't know which ones they are. But a clamp on the tube would help so much!!!

So much for the idea of "the mixing of meds into a gloop should be overseen by professionals". Somewhere there may be pharmacists knowledgeable about such things but I doubt there are many at the local Walgreens. Or Express Scripts. I think this only learned by in the trenches experience with feeding tubes and our own specific medications. Maybe even brands of the meds. To quote Todd Rundgren, " Alone again, naturally." Nah, too depressing. Let's paraphrase Willie: "On our own again, just can't wait to get on our own again. The life I love is making gloop for my PALS ..." :)
 

4tloml

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The life I love is making gloop for my PALS ..." :)

Diane, that cracked me up (in a good way). :) Reminds me of a song by John Salz, "You just have to laugh, or you'll go crazy." No kidding!!!

The change to a mic-key is Thursday. Hurray! We've agreed one dangle up front is enough, so the G-tube's gonna go. :twisted:

But, still gotta get all the meds down a tube. Here's the list:

Benazepril
Bupropion
Citalopram
Clopidogrel
Metformin
Metoprolol
Neudexta
Pioglitazone
Riluzole
Simvastatin
Sitagliptin
Plus the Guaifenesin

He has liquid Multi w/extra D, B12 & E, and Ubiquinol and the MMJ which he can still take orally.

Funny thing...after I tried the Coca-Cola to clear the tube, I read a published article that said never to use it, but when we got to Interventional Radiology (IR), a doc asked my husband's doc if he wanted the Pepsi. (What I wanted was a bottle of wine!) ;)

So I'm using Thursday's tube change for some Wednesday evening experimenting. Figure worst that can happen is it clogs again and he misses a few doses of medicine, or we show up clogged again and they make a referral for a better caregiver.
 
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