Wednesday, September 25, 2013

A PEG Problem

I'm not sure why Pam's PEG tube so frequently gets blocked.  Up until last night, it had only ever blocked during the hydration flushes conducted during the day - even these had me puzzled, for water on its own cannot possibly block a tube, maybe the dissolved meds might exacerbate it, but if they’re truly dissolved (which I cannot guarantee that that’s always the case) then that wouldn’t block the tube either.  But the tube all too frequently got blocked and while I could usually unblock it again, I dreaded what might happen if it blocked during Pam’s overnight PEG feed.

This morning, I found out!

Pam was awoken by me visiting the loo at about 7:00am; she discovered and reported her bedding being wet.  I was in my underpants only and without my spectacles when I investigated.  Sure enough, the feed nozzle had disconnected and the still-going pump had subsequently delivered (and was still delivering) a considerable amount of PEG food, onto Pam’s body and bedding.  The bluey situated between her and her buttock-cushions had caught much of what had been delivered since the blockage, but there was still her nightie and knickers, part of one buttock-cushion, her upper sheet and blanket and the kylie under her buttock-cushions that had been wetted by the PEG food.  Bah!

Anyway, I took much of what I could to the laundry and proceeded to get Pam washed and dressed for her day in the lounge – in the process changing her PEG tube for a nice new one..  I returned to the bedroom and took everything else that was wetted to the laundry and only then did I take a shower and get dressed.  It was good to see the world with my spectacles at last.

That was this morning – now it’s well into the afternoon.

I have rung David Carson of David Carson Electronics (a good friend of ours) and asked him to consider supplying either a moisture sensor or over-pressure sensor to warn me of any future PEG blockages before the messy consequence can eventuate.  David promised me that he will get back to me in a day or so.  He is one of the few I know who appreciate what's available and/or possible to solve this Pammy-problem and additionally has the ability to make it happen.

The current PEG tubes are similar to Pam’s urinary catheters except they’re skinnier – just 4mm outside diameter compared with 4.7mm (I mentioned this in the previous post).  I reckon they’re too skinny given the viscosity of the PEG food, but it will probably be easier to deal with the consequence of the small diameter than having Pam’s surgery modified to allow for a broader tube – a task which might well be impossible.

Here’s a picture of the tube I removed earlier today – it had been thoroughly blocked by the dried PEG food that had set there once the coupling connection had separated.  It took a lot to clean, and I even partially inflated the holding balloon for your benefit.  At least you can get some idea of its width.

Cheers until next time...

Well here it is, night-time on 3rd October 2013 and I reckon I have got a solution for the PEG problem - but only time will tell.  Firstly the picture... you can see, there is a black thing there, in addition to the ordinary stuff.

David Carson GAVE me a plastic box (normally used for electronic thingies). He wouldn't accept any payment, no matter how much I tried to offer and, from the sides of that box, I manufactured this plastic holding-clip, (currently attached to Pam's PEG tube with fishing line, but not for long methinks).

Here's another view.  The clip was cut from the end portion of the plastic box and while I'm aware that if there is a thorough blockage in the future, the PEG end (on the right in this pic) might be forced to slide to the left, up the tapered nozzle; but I doubt if it will.  As I said above, only time will tell.  ...and then I'll tell you, OK?

In case you're wondering, these photos were taken just after I connected and started Pam's nightly feed at 9:32pm a little while ago.  The pink cloth underneath is a folded tea-towel resting on her tummy intended to keep all the plastic apparatus (including the brand-new black plastic holding-clip) off that very part of her - you can even see a bit of her right hand.

Here's a picture of the clip on its own...

It's simplicity-plus, but I won't be able to test it properly until I get to change Pam's PEG tube once again - I managed to destroy the previous one in the process of making this thing. 

With another PEG to play with, I intend to clamp it shut, so that it appears blocked as far as the pump is concerned, fit the clip as shown above and then proceed to pump left-over PEG food.  If all goes well, the nozzle will stay in place and the feed flow will simply stop so that no drips continue in the pump's drip chamber.  With no further drips being evident to the pump's electric eye, the electronics of the pump will sound a very pleasing alarm - and the pump will stop.  I will be grinning, grinning, grinning!

I love looking after Pammy!

It's now only the 7th of October, but I've had enough doubts already about the downstream end, that I modified it.  See if you can see the difference...

What I did was to glue in an insert at the top end (in this view), simply in case the original didn't grip the PEG socket-piece firmly enough.  This one surely will!  Compare this (top end) with how it was in the previous picture (right-most end).  It still fits!

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