From the Guidelines
A PEG tube needs to be replaced when it shows signs of deterioration, such as breakage, occlusion, dislodgement, or degradation, or if a site infection cannot be resolved with antimicrobial treatment, as indicated in the most recent guideline 1. The decision to replace a PEG tube is primarily based on its condition and the presence of complications. According to the espen practical guideline: home enteral nutrition 1, there is no need to exchange a tube system at regular intervals, and replacement will be required eventually because of breakage, occlusion, dislodgement, or degradation. Key factors that necessitate replacement include:
- Breakage or damage to the tube
- Occlusion or blockage of the tube
- Dislodgement of the tube
- Degradation of the tube material
- Site infection that cannot be resolved with antimicrobial treatment
- Fungal colonization with material deterioration and compromised structural integrity Regular inspection of the tube and stoma site is crucial to identify problems early, and patients should contact their healthcare provider immediately if the tube becomes dislodged or damaged rather than attempting to reinsert it themselves. In cases where the tube needs to be replaced, a healthcare provider will typically remove the old tube and insert a new one during an outpatient procedure, using techniques such as the "cut and push" method for bumper-type tubes 1. It's also important to note that the type of tube material can affect its durability, with silicone tubes generally lasting longer than polyurethane ones. Overall, the replacement of a PEG tube should be guided by the presence of complications or deterioration, rather than a fixed schedule, as recommended by the most recent and highest quality study 1.
From the Research
PEG Tube Replacement
- A PEG tube needs to be replaced when it deteriorates or is damaged, which can occur due to various reasons such as occlusion, breakage, or degradation of the tube material 2, 3, 4.
- The longevity of a PEG tube depends on the material used, with polyurethane tubes lasting longer than silicone tubes, with a mean time of 573.9 days for polyurethane tubes and 287 days for silicone tubes 2.
- Replacement of a PEG tube is generally considered a safe procedure, but it can be associated with serious complications such as gastrocutaneous tract disruption and intraperitoneal tube placement, which may lead to chemical peritonitis and even death 3, 5.
- The gastrocutaneous tract of a PEG tube begins to mature in 1-2 weeks after placement and is well-formed in 4-6 weeks, but this process can take longer in some patients 3.
- Clinicians should be aware of the potential complications associated with PEG tube replacement and follow strict guidelines to minimize these risks 3, 5.
- The need for PEG tube replacement can be determined by regular monitoring of the tube's condition and function, and replacement should be performed when the tube is no longer functional or is causing complications 4, 6.
Factors Affecting PEG Tube Longevity
- Material of the PEG tube: polyurethane tubes last longer than silicone tubes 2.
- Duration of use: PEG tubes can be used for several months or years, but their longevity decreases over time 2, 4.
- Patient factors: age, underlying medical condition, and presence of complications can affect the longevity of the PEG tube 5, 4.
- Tube maintenance and care: regular cleaning and maintenance of the PEG tube can help extend its longevity 4, 6.