A Percutaneous Endoscopic Gastrostomy, or PEG tube, is a feeding tube inserted through the abdominal wall directly into the stomach. Its primary function is to deliver nutrition, fluids, and medications when oral intake is not feasible or adequate. Understanding potential risks and complications is important for patients and caregivers to recognize issues early and ensure proper management.
Common Local Complications
Issues frequently arise around the stoma, the opening for the PEG tube. Infection at the stoma site is common, characterized by redness, swelling, increased tenderness, pain, and sometimes a purulent discharge. A fever may also accompany a more severe infection.
Leakage of gastric contents around the tube is another frequent concern, often from a poor fit or granulation tissue. This leakage can irritate and break down skin due to acidic stomach contents. A barrier cream can help manage this.
Granulation tissue, excess tissue around the stoma, is also common. It is typically red, moist, and may bleed easily, often itching or burning. While a normal part of healing, excessive granulation can contribute to leakage and soreness. These local complications are often manageable but require careful attention.
Serious Internal Complications
Beyond the local site, internal complications can be more severe. Peritonitis, an inflammation of the abdominal lining, can result from the leakage of stomach contents into the abdominal cavity, often due to tube malfunction or dislodgement. This condition is a medical emergency that can lead to severe abdominal pain and systemic infection.
Aspiration pneumonia, the inhalation of stomach contents into the lungs, poses a risk, particularly if feeding occurs when the patient is not properly positioned. This can cause respiratory distress and lung infection. Bowel perforation, an accidental puncture of the bowel, is a rare but serious complication that can occur during the initial PEG tube insertion or if the tube migrates.
Hemorrhage, or bleeding, can occur internally or from the stoma site, ranging from minor oozing to severe bleeding requiring immediate medical intervention. Buried bumper syndrome occurs when the internal bumper of the PEG tube migrates into the abdominal wall, becoming embedded. This can lead to tube malfunction, pain, leakage, and serious infections like peritonitis or necrosis of the abdominal wall.
Tube-Related Issues
Mechanical or functional problems related to the PEG tube can also arise. Tube dislodgement occurs when the tube comes out partially or completely, often due to accidental pulling or a deflated internal balloon. If the tube comes out entirely, prompt medical attention is necessary, as the stoma tract can close rapidly, requiring urgent reinsertion.
Tube clogging is a common problem, frequently caused by inadequate flushing, medication residue, or formula buildup. This blockage prevents the flow of nutrition or medication and can be frustrating to manage. Attempting to flush with warm water is often the first step, but forceful attempts should be avoided to prevent tube damage.
Tube breakage or damage, such as cracks or holes, can compromise the feeding system’s integrity. While designed for long-term use, wear and tear can occur. Any damage necessitates assessment by a healthcare provider, as it can lead to leakage or improper delivery of feeds and medications.
Minimizing Risks Through Proper Care
Proactive measures in PEG tube care significantly reduce the likelihood of complications. Proper stoma site hygiene involves daily cleaning with mild soap and water, ensuring the area is thoroughly dried. While some initial redness or crustiness is normal, consistent cleaning prevents bacterial buildup and irritation. Dressings should be used for drainage; otherwise, leaving the site open to air is often preferred to reduce infection risk.
Regular flushing of the tube with water is important to prevent clogs, especially before and after each feeding or medication administration. For continuous feeds, flushing with 30 mL of water every four hours is recommended, while 15 mL is often sufficient between individual medications. When administering medications, it is advisable to use liquid forms whenever possible, or to finely crush tablets and dissolve them completely in water, administering them one at a time.
Securing the tube properly prevents pulling or dislodgement, which can cause significant issues. Ensuring a small amount of free movement, typically 0.5-1 cm, between the skin and the external bumper helps prevent excessive pressure and potential tissue damage. Regularly monitoring the skin around the stoma for any signs of irritation, breakdown, or infection allows for early intervention. Positioning the patient with their head elevated 30-45 degrees during and for at least 30-60 minutes after feeds helps reduce the risk of aspiration.
Recognizing When to Seek Medical Help
Prompt recognition of certain signs and symptoms is important for patient safety. Severe pain at the stoma site or in the abdomen, especially if it worsens or is accompanied by rigidity, can indicate a serious internal complication like peritonitis. A high fever or chills are systemic signs of infection that warrant immediate medical evaluation.
Significant leakage from the stoma that does not stop or excessive bleeding, particularly bright red blood, requires urgent attention. Difficulty breathing or persistent coughing during or after feeds may signal aspiration, where stomach contents enter the lungs. Any tube dislodgement or breakage should be reported to a healthcare provider immediately, as the tract can close quickly, requiring prompt reinsertion.
Persistent nausea, vomiting, or diarrhea, especially if severe or leading to dehydration, also indicates a need for medical assessment. Worsening redness, swelling, or pus around the stoma despite routine care suggests a localized infection that may require professional treatment, including antibiotics.