Is a percutaneous endoscopic gastrostomy (PEG) tube, placed 8 days ago, malfunctioning and exhibiting signs of inflammation, such as erythema (redness)?

From the Guidelines

You should seek immediate medical attention for your PEG tube that is not functioning and appears red after placement 8 days ago. These symptoms suggest possible infection or displacement of the tube. Contact your healthcare provider or go to the emergency department today. In the meantime, do not attempt to use the tube for feeding or medication. The redness around the insertion site indicates inflammation or infection, which may require antibiotics such as cephalexin 500mg four times daily for 7-10 days, as suggested by general medical practice, although the provided evidence does not specify the exact antibiotic regimen 1.

The non-functioning aspect could be due to tube blockage, displacement, or kinking. A healthcare professional needs to assess the tube's position, possibly with imaging, and may need to flush it with warm water or replace it entirely. PEG tubes typically need 7-14 days to form a mature tract, so complications at 8 days are concerning as the tract is still healing. Never force anything through a non-functioning tube as this could cause serious complications including peritonitis if the tube has become dislodged.

According to the most recent and highest quality study, if the infection cannot be resolved by topical and systemic antimicrobial treatment, the tube should be removed 1. It's also important to note that the durability of a PEG tube system is primarily linked to its careful handling, and there is no need to exchange a tube system at regular intervals, but replacement will be required eventually because of breakage, occlusion, dislodgement, or degradation 1.

Some key points to consider in the management of PEG tubes include:

• Monitoring the site for signs of infection, such as erythema, purulent discharge, or fever 1
• Using aseptic technique for dressing changes and tube care 1
• Avoiding occlusive dressings and promoting a dry environment to prevent skin maceration 1
• Flushing the tube regularly to prevent blockage 1
• Considering replacement of the tube if it becomes blocked, dislodged, or degraded 1

From the Research

Peg Tube Complications

• The most frequent complication reported for percutaneous endoscopic gastrostomy (PEG) is peristomal wound infection, which occurs in as many as 30% of patients 2.
• Antibiotic prophylaxis can reduce the incidence of peristomal wound infection associated with PEG insertion 2, 3, 4.
• A study found that patients who received antibiotic prophylaxis had mean daily combined wound scores that were significantly lower than those of patients without antibiotic prophylaxis 2.
• Another study found that the combined use of short-term cefotaxime and clindamycin seems to be effective in reducing the incidence of acute complications due to PEG placement without increasing side-effects 3.

Peg Tube Functionality

• If the peg tube is not functioning 8 days after placement, it may be due to a blockage or other complication 5.
• Tube blockage is one of the most prevalent complications of PEG tubes 5.
• Redness around the tube site could be a sign of infection or other complication 2, 3, 4.

Recommendations

• It is essential to monitor the patient closely after PEG tube placement and to report any signs of complications, such as redness, swelling, or difficulty with tube function 2, 3, 4, 5.
• Adequate prior preparation of the patient and exhaustive maintenance of the tube can reduce the appearance of complications 5.