Verification of PEG Tube Placement with CT Abdomen and Pelvis
To verify proper PEG tube placement with CT abdomen and pelvis, a water-soluble contrast study should be ordered to confirm correct positioning before use of the tube.
Verification Methods for PEG Tube Placement
- Water-soluble contrast study is the most reliable radiographic method to confirm proper PEG tube position when using CT abdomen and pelvis 1, 2
- This verification is especially important after blind replacement of a PEG tube to rule out malposition before using the tube 1
- Air insufflation can be used as a relatively safe alternative procedure for PEG tube replacement verification 3
When Verification is Necessary
- After blind replacement of a PEG tube, especially when there is any doubt about proper positioning 1
- When a PEG tube has been inadvertently removed or dislodged, particularly within the first four weeks after placement 1, 4
- When there are signs of tube migration or displacement, such as inability to administer feeds or medications 5
- When high gastric residuals are present, which may indicate improper tube positioning 4
Additional Assessment Methods
- pH confirmation of gastric content (pH 5 or less) can be used as a bedside method to verify gastric placement 1, 2
- Irrigation of the tube with 3-50 ml sterile water without resistance or leakage can help assess proper positioning 1
- Assessment of external length of the tube and manipulation via rotation and in-out movement can provide additional confirmation 1
Important Considerations
- Verification is critical within the first four weeks after initial placement, as the stoma tract may not be fully mature 1
- For tubes placed less than two weeks prior, replacement should be done endoscopically or radiologically through the same site 1
- Between two and four weeks after initial placement, blind replacement can be attempted but must be followed by a water-soluble contrast study 1
- After four weeks, direct replacement can be safely attempted before the track closes completely, but verification is still recommended 1, 2
Potential Complications of Improper Placement
- Pneumoperitoneum can occur if the tube is not properly positioned in the stomach 6
- Gastric outlet or duodenal obstruction may result from tube migration 5
- Early buried bumper syndrome can occur if the internal bolster gets embedded in the subcutaneous tissue 7
Pitfalls to Avoid
- Failure to verify tube position after blind replacement can lead to serious complications including peritonitis 1
- Using smaller diameter tubes (less than 15 Charrière) increases the risk of clogging and should be avoided 1
- Excessive tension on the external fixation plate can cause pressure necrosis and tube dislodgement 1, 4
- Inadequate incision size at the puncture site (less than 8mm) can cause pressure-related lesions 1