A Case of Early PEG Tube Dislodgment—What Can We Learn?

By Sylvia Foley, AJN senior editor

Figure 2. A PEG tube (or G-tube) is inserted through the skin, subcutaneous tissue, and abdominal wall into the stomach. Illustration courtesy of the StayWell Company, Yardley, PA. A PEG tube (or G-tube) is inserted through the skin, subcutaneous tissue, and abdominal wall into the stomach. Illustration courtesy of the StayWell Company, Yardley, PA.

Percutaneous endoscopic gastrostomy (PEG) tubes are widely regarded as “one of the most useful” means of delivering enteral nutrition—but when things go wrong, the results can be devastating.

Consider the following case, presented in one of June’s CE features, “Early Percutaneous Endoscopic Gastrostomy Tube Dislodgment”: Mr. J. B., a man in his fifties, was involved in a motor vehicle accident and developed an extending, chronic subdural hematoma. After undergoing an emergency craniotomy, he suffered neurologic deterioration and respiratory failure. Treatment included the placement of a PEG tube for nutritional support, but when Mr. B. later became confused and agitated, he forcibly dislodged the tube. The bedside nurse “inserted a Foley catheter to replace the PEG tube, drew an air bubble out of the catheter to confirm gastric placement, noted this, and then reported the event to the facility’s attending physician, who acknowledged and approved […]