By Sylvia Foley, AJN senior editor
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 the action.” No further confirmatory testing was done.
But the tip of the tube was in the wrong place, emptying into Mr. B.’s peritoneum rather than his stomach. By the time the error was discovered, sepsis had set in. Despite numerous measures to address this, the patient developed peritonitis and died soon afterward.
Learning from tragedy. In this article, authors Jamie Marie O’Rear and Joseph Prahlow describe the sequence of events in detail—and then delve deeper, exploring whether this outcome could have been avoided. They cover gastrostomy techniques, complications, and preventive strategies. They also provide a list of basic PEG tube management points, and caution that “signs of complications may be subtle, and early identification requires astute observation and a high index of suspicion.” For example, one major complication, tube migration, should be suspected
- when the patient has pain during feeding,
- when there is resistance to flow related to peritubal leakage, or
- when it’s difficult to advance, pull, or rotate the tube.
For more information, read the article, which is free online.