A percutaneous endoscopic gastrostomy (PEG) tube is a medical device inserted through the abdominal wall directly into the stomach, providing a pathway for nutrition, fluids, and medications. While a PEG tube can improve quality of life for individuals unable to consume enough by mouth, its accidental dislodgement can be an alarming event for patients and caregivers. Understanding the appropriate steps to take can help manage the immediate concern and prevent potential complications.
Immediate First Aid Steps
Should a PEG tube accidentally become dislodged, the first step is to remain calm. Note the exact time the tube came out for medical professionals. Immediately cover the stoma site, the opening in the abdomen where the tube was inserted, with a clean, dry cloth or dressing to prevent gastric contents from leaking onto the skin and to keep the area clean.
Next, assess the situation carefully. Observe the tube itself: check if the balloon, if it’s a balloon-retained tube, is still attached and if it is intact or deflated. If the tube is a balloon type, and the balloon is still inflated and causing pain, medical attention is needed promptly. Do not attempt to force the tube back into the stoma if you encounter resistance, as this could cause further injury or misplacement.
If the PEG tube has been in place for more than two months, and the stoma tract is considered mature, a trained caregiver may attempt to gently reinsert a replacement tube or a Foley catheter of the same size to maintain the opening. Lubricate the tip of the tube with a water-based lubricant before attempting reinsertion. The tube should slide in smoothly without excessive force.
After reinsertion, if attempted, secure the tube to the skin with tape. However, do not use the newly reinserted tube for feeding, medication, or flushing with water until its proper placement within the stomach has been confirmed by a healthcare professional. Confirmation is essential to avoid serious complications such as feeding into the abdominal cavity.
Preventing Complications While Waiting for Medical Help
While awaiting medical assistance, maintaining the integrity and cleanliness of the stoma site is important to prevent complications. The stoma, or the created opening, can begin to close rapidly, sometimes within hours, if nothing is placed in the tract. To help keep the tract open, some sources suggest keeping a spare tube or a Foley catheter readily available for temporary reinsertion if trained to do so.
Ongoing hygiene is essential to prevent infection at the site. Clean the skin around the stoma with mild soap and water daily, drying the area thoroughly. Avoid using hydrogen peroxide or harsh cleansers, as these can irritate the skin and potentially lead to further complications.
Monitor the site for any signs of infection, which can include increased redness, swelling, warmth, tenderness, or a foul odor. The presence of thick green or white discharge from the stoma also indicates a potential infection. Applying a split gauze dressing around the tube and under the external bumper can absorb any discharge and protect the skin, but avoid overly thick dressings or excessive pressure. Change dressings regularly, especially if they become wet, to maintain a dry environment around the stoma.
When to Contact Medical Professionals
Promptly contacting medical professionals is essential when a PEG tube becomes dislodged. If the tube was placed recently, within the first two to eight weeks, immediate medical evaluation is necessary. During this initial period, the tract leading to the stomach is still forming and immature, increasing the risk of serious complications like peritonitis if gastric contents leak into the abdominal cavity. In such cases, attempting self-reinsertion is not recommended.
Contact a healthcare provider immediately or go to an emergency department if any concerning symptoms develop. These include severe abdominal pain, persistent uncontrolled leakage of stomach contents, or any signs of infection such as spreading redness, warmth, increased tenderness, pus draining from the site, or fever. Bleeding from the stoma site, especially if it is significant, also warrants immediate medical attention.
Even if no alarming symptoms are present, a healthcare professional should be contacted as soon as possible, ideally within a few hours, to arrange for proper reinsertion or assessment. If a trained caregiver successfully reinserts a temporary tube, medical confirmation of its placement is still necessary before resuming tube feedings or medications. Always have emergency contact numbers readily available, including those for the healthcare provider, a specialized feeding tube service, or the nearest emergency department.
What to Expect After Medical Intervention
Upon seeking medical intervention for a dislodged PEG tube, healthcare professionals will first assess the patient’s overall condition and the stoma site. This assessment helps determine the best course of action, considering factors such as the maturity of the gastrocutaneous tract and the presence of any complications. They will examine the stoma for signs of injury or infection and evaluate the surrounding abdominal area.
If the tract is mature and no complications are present, a new PEG tube, often a balloon-tipped type, may be reinserted at the bedside by qualified personnel. In some cases, a temporary catheter, such as a Foley catheter, might be placed initially to keep the stoma open until a permanent tube can be inserted. For tubes dislodged within the first few weeks of placement, when the tract is immature, endoscopic guidance or surgical intervention may be necessary to ensure safe and accurate tube replacement.
After reinsertion, confirmation of the tube’s correct placement within the stomach is essential before any use. This is typically achieved through methods such as checking the pH of aspirated stomach contents, which should be acidic, or by performing a radiologic contrast study, such as an X-ray, to visually confirm the tube’s position. Follow-up care will involve instructions on proper stoma site hygiene, monitoring for any signs of complications, and guidance on resuming tube feedings and medications.