What are the recommendations for caregivers of patients with percutaneous endoscopic gastrostomy (PEG) tubes?

Recommendations for Caregivers of Patients with PEG Tubes

Caregivers of patients with PEG tubes should perform daily site monitoring, proper cleaning, appropriate dressing changes, and tube maintenance to prevent complications and ensure optimal nutrition delivery. 1

Site Monitoring and Cleaning

• For newly placed PEG tubes (first 5-7 days):

  • Clean the site daily with 0.9% sodium chloride, sterile water, or freshly boiled and cooled water 1
  • Use a sterile Y dressing that doesn't shed fibers, placed under the external disc plate 2
  • Avoid occlusive dressings as they promote moisture and lead to skin maceration 2, 1

• For established PEG sites (after healing, approximately one week):

  • Clean twice weekly with a clean cloth using fresh tap water and soap 2
  • Thoroughly dry the skin after cleaning 2
  • Showering, bathing, and swimming are possible (cover the site with a waterproof dressing when swimming in public pools) 2

Tube Maintenance

• Proper positioning:

  • Maintain 0.5-1 cm free distance between the skin and external bolster 2, 1
  • Avoid excessive traction on freshly inserted PEG tubes 1
  • Ensure the external fixation plate is subjected to very low traction without tension immediately after placement 2

• Regular movement:

  • Rotate the tube daily once the tract has healed (after about one week) 2, 1
  • Move the tube inwards at least once weekly (2-10 cm) and return to initial position 2, 1
  • Exception: Do not rotate gastrojejunostomy tubes or gastrostomy tubes with jejunal extensions (only push in and out weekly) 2

• Tube flushing:

  • Flush with 30-40 ml of water before and after each feeding and medication administration 1
  • Avoid using carbonated drinks or acidic juices to unclog tubes 1

Complication Prevention and Management

• Buried Bumper Syndrome (BBS) prevention:

  • Watch for warning signs: difficulty mobilizing the tube, leakage around insertion site, feeding pump alarms, abdominal pain, chronic site infections, resistance when administering feeds 2
  • Ensure proper tube movement and rotation to prevent this severe but preventable complication 2, 1

• Infection management:

  • Monitor daily for signs of bleeding, pain, erythema, induration, leakage, and inflammation 1
  • If infection is suspected, obtain a swab for microbiological examination 1
  • Apply topical antimicrobial agents to the entry site and surrounding tissue 1
  • Consider systemic antibiotics for persistent infections 1

• Skin protection:

  • Apply barrier film or cream to protect surrounding skin 1
  • Consider hydrocolloid wafer as a keyhole dressing for persistent issues 1

Education and Support

• Training requirements:

  • Caregivers should receive comprehensive training on tube care and feeding techniques 1
  • Training should include recognition of complications and when to seek medical attention 1
  • Clear written or visual materials should be provided 2
  • Information about which department or service to contact in emergencies should be given 2

• Nutritional planning:

  • An individual nutrition plan should be developed 1
  • Calculate daily calorie and fluid requirements 1
  • Regular dietetic follow-up is essential (83% of patients in one study had dietetic assessment following discharge) 1, 3

Common Pitfalls to Avoid

• Applying excessive pressure between internal and external fixation devices (risk factor for BBS) 2
• Neglecting daily rotation and weekly inward movement of established tubes 1
• Using occlusive dressings that promote moisture and lead to skin maceration 2, 1
• Failing to recognize signs of complications requiring prompt intervention 1
• Inadequate community follow-up after hospital discharge (a study showed that 31% of patients had PEG-related problems) 3

Despite potential complications, PEG tube placement has gained worldwide popularity as a safe enteral access for nutrition in patients with a functional gastrointestinal system 4. With proper caregiver training and adherence to recommended care protocols, complications can be minimized and patient outcomes optimized.