Geriatric Quick Consult      PEG Tube Decisions      Do #5

Review possible complications and negative factors.



Knowledge Action
PEG placement: Describe the procedure used to place the PEG tube.

Many people do not realize it involves endoscopy.

The mortality, major and minor complication rates of the procedure itself are 1%, 3% and 13% respectively.

Major complications include abdominal wall abscesses, necrotizing fasciitis, colocutaneous fistulae and death from sepsis.
  • Describe the procedure.
Local complications: Complications occur in up to 70% of cases.

The majority of these are minor and include local infection at the PEG site, blockage of the tube and "buried bumper syndrome" (rigid internal bumper in the stomach too close to the external bumper on the surface of the abdomen) often resulting in mucus discharge around the tube and slow migration of the internal bumper through the stomach wall.
  • Discuss local complications.
Tube removal: Discuss whether the patient is likely to tolerate having a tube in their stomach.

Some demented patients pull the PEG out if not restrained.
  • Discuss possibility of tube removal.
Aspiration: PEG placement does not prevent aspiration of oral secretions and it may increase the risk of aspirating gastric contents (Review likely outcomes.).

Aspiration pneumonia occurs in 20% to 30% of PEG-fed patients and is a common terminal event.
  • Discuss aspiration.
Complications related to the feed: These include diarrhea, hyperglycemia (in diabetics whose medication was discontinued when they stopped eating) and gastric distension.
  • Discuss complications with tube feeding.
Increased restraint use: PEG feeding is associated with increased restraint use in confused patients to prevent self-extubation.
  • Discuss restraint use.
Increased stool and urine production: Provision of adequate calories and fluid usually results in increased stool and urine production, which may predispose to skin breakdown.
  • Discuss effects of increased stool and urine production.
Decreased mobility and social isolation are direct consequences of tube feeding as the patient is usually confined to their room while the feed is run in.
  • Discuss social consequences.
Loss of pleasure from eating: Most patients with a PEG are no longer offered food orally.

This may be advisable if the PEG was placed to prevent aspiration, but if it was placed because of difficulty with feeding and weight loss, the patient may have enjoyed certain foods and benefited from the nurturing associated with spoon-feeding.
  • Discuss loss of pleasure.
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