From the Guidelines
A PEG tube does not need to be changed or replaced at regular intervals, but rather when it shows signs of breakage, occlusion, dislodgement, or degradation, as stated in the 2020 ESPEN guideline on home enteral nutrition 1. The durability of a PEG tube system is primarily linked to its careful handling, and most transorally placed bumper-type tubes can be maintained for many years. Replacement will be required eventually due to various reasons such as breakage, occlusion, dislodgement, or degradation. Key factors to consider for replacement include:
- Fungal colonization with material deterioration and compromised structural integrity, which requires replacement in a non-urgent but timely manner 1
- Balloon-type replacement tubes may require replacement every three to four months due to balloon degradation 1
- Signs of tube deterioration, such as cracking, stiffening, or discoloration, which may indicate the need for replacement
- Leakage around the insertion site, tube blockage, or mechanical failure of the feeding port, which may also require replacement. Regular maintenance, including daily cleaning and flushing of the tube, is essential to extend tube life and prevent complications.
From the Research
Peg Tube Replacement Frequency
- The frequency of peg tube replacement is not strictly defined, but it is generally considered when the tube is occluded or broken 2.
- A study found that retained PEG tubes for more than 6 months were not associated with more PEG-tube-related complications, suggesting that routine replacement at a fixed interval (e.g., 3-6 months) may not be necessary 3.
- The decision to replace a peg tube should be based on individual patient needs and the presence of complications such as leakage, dislodgement, or obstruction 3.
Factors Influencing Replacement
- 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 2.
- The replacement of a PEG tube should be done with caution, using good control of the replacement tube along the well-formed gastrocutaneous tract, minimal insertion force, and reliable methods for confirming intragastric tube insertion 2.
Clinical Guidelines
- Clinical practice guidelines for percutaneous endoscopic gastrostomy recommend that physicians consider the indications, use of prophylamic antibiotics, timing of enteric nutrition, tube placement methods, complications, replacement, and tube removal for PEG based on available clinical evidence 4, 5.
- These guidelines aim to provide a framework for the management of patients with PEG tubes, including the replacement of tubes when necessary 4, 5.