A Percutaneous Endoscopic Gastrostomy (PEG) tube is a flexible feeding device inserted through the abdominal wall directly into the stomach, bypassing the mouth and esophagus. This tube delivers nutrition, fluids, and medications when a person is unable to swallow safely or adequately. PEG tubes provide enteral nutrition, which utilizes the body’s digestive system. Confirming the tube’s correct placement before every use is a mandatory safety measure.
Why Placement Verification is Essential
Misplacement of a PEG tube carries serious health consequences, making routine verification essential. The primary danger is that a tube migrated out of the stomach can deliver formula or medication into the abdominal cavity. This leads to peritonitis, a severe infection caused by gastric contents leaking into the peritoneal space, requiring immediate medical intervention.
Another major risk is aspiration pneumonia, which happens if stomach contents reflux into the esophagus and are inhaled into the lungs. Tube feedings increase the risk of reflux and aspiration, especially if the tube has moved or the internal stomach bumper has become dislodged. Aspiration pneumonia is a common and potentially fatal complication associated with tube feeding. Misplacement can happen suddenly due to coughing, pulling, or accidental dislodgement.
Routine Methods for Checking PEG Tube Position
Caregivers must use a combination of routine checks to confirm the tube is securely located within the stomach. These checks include assessing the external marker, visually inspecting the stoma site, and testing the acidity of the stomach contents. Using multiple verification methods increases confidence that the tube is correctly positioned before use.
The external marker check is the first line of defense against tube migration. When the PEG tube is initially placed, a measurement is recorded where the tube exits the skin, often marked with indelible ink or a number. Before each use, the caregiver must compare the current external mark to this original measurement. Any significant change in the visible length of the tube outside the abdomen suggests potential dislodgement and requires further investigation.
A visual assessment of the stoma site, the opening where the tube enters the body, is necessary for routine checking. The skin around the tube should be inspected for signs of irritation, redness, swelling, or leakage of gastric contents. A tube pulled too tight or pushed too far inward by the external bumper can cause pressure necrosis or “buried bumper” syndrome. Leakage of gastric juice or formula often indicates the internal holding device is no longer flush against the stomach wall, suggesting migration.
The most reliable routine method for confirming gastric placement is testing the pH of the aspirated stomach contents. To perform this, a syringe is attached to the tube, and a small amount of fluid, typically between 0.5 and 1.0 milliliters, is gently withdrawn. This aspirate is then placed onto a specialized pH indicator strip. Gastric fluid is highly acidic, and a pH reading between 1 and 5.5 strongly suggests the tube tip is correctly located in the stomach.
What To Do If Placement Is Uncertain
If any routine check suggests potential tube displacement, immediate action is required to prevent serious complications. The first step is to immediately stop all administration of formula, water, or medication through the tube. Nothing should be introduced until its correct position has been definitively confirmed.
An uncertain result might include a significant change in the external tube marking or the inability to aspirate gastric contents during the pH check. If the pH reading is above 5.5, the stomach contents may be diluted or neutralized, making the tube’s location ambiguous. In such cases, the pH test should be repeated after waiting 30 to 60 minutes, provided the patient shows no signs of distress.
While awaiting professional guidance, the tube must be secured firmly to the abdomen to prevent further movement or accidental removal. The caregiver should then immediately contact the prescribing healthcare provider, such as a nurse, physician, or medical team, to report the uncertainty. If the patient exhibits signs of severe distress, such as sudden abdominal pain, difficulty breathing, or fever, emergency services should be contacted immediately. The healthcare team may require an X-ray to confirm the tube’s exact location, as this is the definitive method for placement verification.