"To the appropriate RAH medical professionals re Pam Fiesley’s dislodged PEG tube,
When Pam came home some days after the insertion of her new Jejunum PEG tube, I found the tube ridiculously long as it was getting caught regularly, because of its length, around Pam’s abdomen and elsewhere during the normal manipulations of her, needed for her washing, dressing and lifter-sling implementations.
Here is a picture of the PEG tube that came away. It was sitting on a Mildura Base Hospital bench when I took the picture (they wanted to keep it, for some reason). It would seem at first site that the 'T" piece which would have been in Pam's jejunum, would have been ample as a locking device, but sadly it’s nothing of the sort.
It’s made of the same soft rubber as the rest of the PEG tube, and has also been split completely along its length to allow an even distribution of the feed. This slit however, makes it even more flimsy and entirely useless as a locking device. Remember, the tube used to be 51cm (duh, that’s over ½ a metre) longer – and maybe I should have left it so. Who knows? As I said above, I dare say I'll soon find out!
A couple of days have come and gone, and there's quite a bit to add...
I am now writing this on Saturday, 30th March and yesterday (Good Friday) Pam arrived back home by ambulance (via an ultra-short pause at MBH following the flight) and was in my care at 3pm. This was the scheduled time for one of Pam's 200ml hydration flushes and this particular one is not medicated. All went well although it was annoying that the input nozzle didn’t seem to be designed for the syringes I use for hydration. It was quite ‘loose’.
5pm came, and another (this time medicated) hydration flush was uneventful as was the 7pm medicated flush. But at 9pm when I gave Pam a 50ml pre-flush of Nexium anti-nausea, prior to her 9:30 PEG feed, the tube promptly blocked and no amount of effort would overcome the blockage. There was no point attempting to pump her nightly PEG feed because this blockage seemed to be meaning business – and so I rang 000 for an ambulance.
Pam was taken to Mildura Base Hospital (MBH) and they spent ages trying to unblock the tube. I reckoned that it was probably the Nexium, dissolved as it was to free the tiny time-release capsules and it was them, thought I, that had caused the blockage. I later learned some confirming input in that the gauge of this PEG is significantly less than the Stomach PEG that it replaced and the reason that it hadn’t blocked with Nexium prior to my doing it was that the hospital staff of both hospitals, were crushing the Nexium tablets as they did with every other tableted med. This may have avoided the potential blockage, but was a definite no-no according to the instructions written on the packet. (Hospital staff personnel are seemingly oblivious to instructions on tablet packs, probably because they only deal with the foils already taken from the packs, and a tablet is a tablet.) I have also discovered since beginning this paragraph the gauge of the blocked PEG is vastly smaller than the one it replaced i.e. the one that fell out.
The yellow tube is from the tube that fell out - simple single tube. The bluey-grey one (i.e. the one that blocked yesterday) is compound, but clearly not a tube-within-a-tube as was the stomach PEG. Here, the tiny hole is for the locking balloon and the larger of the two is for food flow. Compare this diameter with that of the yellow. No wonder it blocked, in hindsight.
This has me wondering about the new one fitted today. It's different in appearance, but this sort of a test is not appropriate ... yet.
It was getting late and the ambulance officers offered to take Pam home to bed rather than leave her on a trolley all night as the hospital had no bed space. So at 2:50am this morning, I put Pam to bed. The ambulance guys then recommended that I make an early booking (8am) so that they could get Pam back to the MBH at a reasonable time to either succeed with the unblocking or to Air Ambulance Pam back to Adelaide for a new PEG.
Whacko! I applied the fancy
dressing over the PEG site, rather than wait any longer – while the staff
booked the ambulance to take Pam home. That was at about 2:30pm and I
decided to dash home to warm the place up and prepare for Pam’s alleged
immanent return. As I said – at 4pm, she turned up. (Not quite as
immanent as I’d hoped for!)
When I got there, I was quickly relieved to learn that if the food had indeed been emptying into Pam’s abdomen space, it would have been painful – but it wasn’t. An X-ray confirmed that the PEG tube was where it was supposed to be and that Pam was (merely) terribly constipated.
Pam was admitted to Ward 3 (room 17), stayed the night at the Base and I volunteered to look after many of the hydration flushes, four of them being medicated and also Pam’s overnight PEG feed. I get to bring her back home after lunch today, Sunday 7th.