What should I do for a patient with a torn percutaneous endoscopic gastrostomy (PEG) tube, who likely has a complex medical history including dysphagia, neurological disorders, or other chronic conditions, and relies on enteral nutrition via the PEG tube?

Management of a Torn PEG Tube

A torn PEG tube requires immediate replacement, which typically necessitates emergency department evaluation or urgent gastroenterology consultation, as the patient depends on this access for nutrition and the stoma tract can close within hours if the tube is not replaced promptly. 1

Immediate Assessment and Action

Determine the severity and location of the tear:

• If the tube is completely dislodged or torn at the external portion, the stoma tract will begin closing within 4-8 hours, making replacement progressively more difficult 1
• If the tear is minor (small crack or leak) but the tube remains in position, you may have slightly more time, but replacement is still urgent 1

The patient should be sent to the ED or have urgent gastroenterology consultation for the following reasons:

• PEG tube replacement requires endoscopic or fluoroscopic guidance in most cases, particularly if the tract is not well-established (less than 6-8 weeks old) 1
• Attempting to feed through a torn tube risks peritoneal contamination and peritonitis 1
• Delayed replacement may necessitate a completely new PEG placement procedure rather than simple tube exchange 1

Critical Time Considerations

The stoma tract begins to close rapidly once the tube is removed or displaced:

• Well-established tracts (>6-8 weeks old) may remain patent for 4-8 hours 1
• Newer tracts (<6-8 weeks) can close within 2-4 hours 1
• This makes same-day replacement essential to avoid the need for repeat endoscopic placement 1

What NOT to Do

Do not attempt the following:

• Do not try to repair the torn tube with tape or other materials, as this will not prevent leakage and risks peritonitis 1
• Do not attempt to feed through a torn or leaking tube 1
• Do not delay seeking professional help hoping the situation will resolve 1
• Do not attempt to replace the tube yourself unless you have specific training in PEG tube replacement and the tract is well-established 1

Temporary Measures While Arranging Transfer

If there will be any delay in getting to the ED:

• Keep the torn tube in place if possible to maintain tract patency, even if it's leaking 1
• If the tube has completely fallen out and the tract is well-established (>6-8 weeks old), you may attempt to place a Foley catheter of similar size through the tract to maintain patency until definitive replacement 1
• Cover the site with sterile gauze if there is leakage 1
• Keep the patient NPO (nothing by mouth) to prevent aspiration risk 1

Special Considerations for High-Risk Patients

Patients with neurological dysphagia are at particular risk:

• These patients have no alternative route for nutrition and medications 1
• They often cannot protect their airway, making oral feeding dangerous 1
• Delayed replacement may result in aspiration pneumonia if oral feeding is attempted 1

The mechanical complication rate is higher in neurological patients, often due to medication administration through the tube, making proper replacement technique and tube selection important 1