HINT: How do I prepare and administer Polyethylene Glycol (PEG) 3350 through a feeding tube?

Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.

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HINT: How do I prepare and administer Polyethylene Glycol (PEG) 3350 through a feeding tube?

SITUATION: 

This QuickHit! comes from a home care nurse who consulted Connected Care Live to ask if it is appropriate to mix Polyethylene Glycol (PEG) 3350 with formula and administer it in a continuous enteral feed?

BACKGROUND:

Children with medical complexity experience rates of constipation even higher than those reported in the general paediatric population. Increased rates of constipation in this vulnerable group can be due to:

• presence of chronic conditions (e.g. metabolic and neurologic)

• differences in their anatomy and mobility (e.g. sitting posture and ability to ‘bear down’)

• medication usage (e.g. pain medications, some anticonvulsants)

• reliance on specialized diets (e.g. limits to intake of fibre, fluid restrictions)

Health Care Providers partner with children and families to treat constipation in the paediatric population through education, dietary and behavioural modification, counseling and use of medications including laxatives and stool softeners.

Polyethylene Glycol (PEG) 3350 is one of the most common medications prescribed from hospital to home care for paediatric constipation. PEG works as a laxative by increasing the fecal water content to soften stools. The effect of PEG is not immediate, and may take 2-4 days before a bowel movement occurs. PEG comes in a powder form and is also called pegFlakes, Restoralax or Lax-A-Day. 

PEG is considered non-toxic and safe for long term use in the population of children with chronic and ‘difficult to treat’ constipation, it is often prescribed as a daily medication and a component of a child’s maintenance bowel health regime.

ASSESSMENT:

Before giving PEG 3350 assess for and report any acute and potentially urgent gastrointestinal symptoms to the child’s family caregiver and/or health care provider including signs of:

• Blockage in the gastrointestinal tract

• Sluggish movement through the intestines

• Acute abdominal pain

• Increase in nausea, vomiting

• Rectal bleeding

• Change in bowel habits lasting longer than 2 weeks

RECOMMENDATION:

Connected Care recommended for this consult that it was acceptable to mix the PEG 3350 in formula and deliver it via the child’s enteral feed/tube. It was cautioned, however, that the total medication administration time is to be within 20 minutes.  

Considerations in preparing and administering PEG 3350

Contraindication:

• Allergies to this drug or any part of this drug

Caution: 

• Urgent signs of acute gastrointestinal issues (see above and use this link for more information) 

• Kidney disease and/or children who may be fluid/volume restricted

Administration:

• PEG 3350 comes in individual packets or a bulk bottle. When measuring follow the prescribed order and use the dosing cap/spoon that comes with the PEG, to get an accurate dose.

• Mix the PEG 3350 powder in 1/2 to 1 cup (120 to 240 mL) of liquid such as water, juice, soda, or formula. Stir well until the powder dissolves.

• To promote effectiveness, administer the entire dose, as tolerated, within a maximum of 20 minutes. PEG is not to be mixed into a continuous feed as it is to be given right away.

• Deliver by mouth or any enteral feeding tube (NG, G-tube, J-tube). When by tube, ensure that the PEG powder has fully dissolved before giving it, especially when administering this medication into an enteral tube and flush well after administration.

• Give PEG 3350 for as long as the health care team has ordered for it to be taken. Stopping too soon may contribute to relapse of the symptoms. 

• Monitor for side-effects of the of PEG 3350

  • Abdominal cramps

  • Gas, bloating (fullness), nausea

  • Loose, watery, or more frequent stools

  • Dehydration if frequent/loose/large stooling

Track, document and communicate observations of the ‘results’ of the effects of the treatment with child’s family and health care team -  along with any side effects that may persist.

Click here to visit AboutKidsHealth for more information about Polyethylene Glycol (PEG) 3350,

Consider consulting Connected Care Live if you or the child/family are unsure or have further questions about the preparation or administration of PEG 3350.

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