From the Guidelines
A Percutaneous Endoscopic Gastrostomy (PEG) tube does not significantly reduce the risk of aspiration pneumonia, contrary to what many believe. Aspiration can still occur with a PEG tube in place through several mechanisms, including reflux of gastric contents into the esophagus and subsequent aspiration into the lungs, as well as aspiration of oral secretions if a patient has difficulty managing their own saliva 1. Additionally, if tube feedings are administered too quickly or in too large a volume, this can increase the risk of regurgitation and subsequent aspiration.
To minimize aspiration risk with a PEG tube, several precautions should be taken:
- Elevate the head of the bed 30-45 degrees during feeding and for 30-60 minutes afterward
- Verify proper tube placement before each feeding
- Administer feedings at the prescribed rate (not too quickly)
- Check for residual volumes before feeding if ordered
- Ensure proper medication to manage gastroesophageal reflux if needed
The misconception that PEG tubes prevent aspiration stems from the idea that bypassing the oral route eliminates aspiration risk, but research has shown that aspiration pneumonia rates remain significant in tube-fed patients due to these alternative pathways for aspiration 1. According to the most recent and highest quality study, PEG feeding may reduce but will not eliminate the risk of aspiration 1. It is essential to consider the individual patient's needs and take a comprehensive approach to minimize the risk of aspiration pneumonia.
From the Research
Aspiration Risk with PEG Tube
- A Percutaneous Endoscopic Gastrostomy (PEG) tube can reduce the risk of aspiration, but it does not completely eliminate the risk 2, 3.
- Aspiration can still occur with a PEG tube in place due to various factors, such as the patient's underlying medical condition, the position of the patient's body, and the method of feeding 2, 4.
Factors Influencing Aspiration Risk
- Patient-related factors, such as neurological disease, esophageal surgery, and severe debilitation, can increase the risk of aspiration 3.
- The presence of certain comorbidities, such as dementia, malnutrition, cerebrovascular disease, cardiac arrhythmias, congestive heart failure, COPD, paralysis, alcohol abuse, and psychoses, can also increase the risk of aspiration 5.
Preventing Aspiration with PEG Tube
- Direct percutaneous endoscopic jejunostomy (DPEJ) tube placement has been shown to decrease the incidence of aspiration pneumonia in high-risk patients 3.
- The use of cisapride, a prokinetic agent, may also play a role in preventing aspiration in patients fed via PEG tube 6.
- Adequate prior preparation of the patient and exhaustive maintenance of the tube can reduce the appearance of complications, including aspiration pneumonia 4.
Complications of Aspiration with PEG Tube
- Aspiration pneumonia is a significant complication of PEG tube placement, and can lead to increased mortality, longer hospital stays, and higher healthcare costs 5.
- Patients with a PEG tube who develop aspiration pneumonia are at increased risk of severe sepsis, septic shock, and augmented healthcare consumption 5.