Complications and common problems associated with PEG

These include:

• redness around stoma site
  • After cleaning the use of a barrier (e.g. Cavilon) cream will reduce redness and soreness. Some degree of mild erythema is expected. Any concerns should be reported to GP, Nutrition Nurse Specialist or discharging hospital
• excoriation of stoma site
  • can be caused by too much movement of the feeding tube in and out of the stoma
  • check the position of external flange
  • excoriation
    • should be treated by using an appropriate skin protector. If the area is raw and weeping further treatment may be required
  • seek advice from the GP, Nutritional Nurse Specialist or discharging hospital
• infection around stoma site
  • possible signs and symptoms may include; Inflammation, redness, discharge, pain, malodour, localised heat
  • wound swab may be indicated
  • contact the patient's GP, local District Nurse or Nutrition Nurse Specialist for advice
• granulation around stoma site
  • over granulation is a problem with some stoma sites, though its cause is still unknown it may be treated in a non traumatic way (use of double layer foam dressings, a mild prescribed steroid cream or the use of silver dressings)
  • silver nitrate sticks should not be used
• gastric leakage from initial stoma site
  • if this occurs the tube may need to be adjusted
  • advice must be sought immediately from the GP, Nutritional Nurse Specialist or discharging hospital
  • skin should be protected by an appropriate skin protector
• vomiting or pain associated with feeding
  • any of these symptoms should be reported immediately to a dietitian, doctor or Nutrition Nurse Specialist
• PEG tube comes out
  • the PEG should only be removed by a suitably trained person, after a risk assessment has been done. Each patient with a PEG must have a replacement tube in their home for emergency use
  • a replacement balloon gastrostomy tube should be inserted by a suitably trained person as soon as possible. Prior to replacement check that the old gastrostomy tube is intact. If the tube is not intact, the Nutrition Nurse Specialist or a doctor must be informed immediately
  • Record type, size, batch number, & date inserted, volume of sterile water used to inflate the balloon. Contact the home enteral feeding team to arrange delivery of ancillaries, arrange appointment for routine tube change
• blockage
  • a suitably trained individual may attempt to unblock the tube by flushing with clean warm water in a large volume enteral syringe, using a push / pull technique
  • massage the length of the tube between finger and thumb
  • use cooled boiled or sterile water (from a freshly opened container) for children under the age of 12 months, or those who are immunocompromised
  • if initial attempts to unblock the tube are not successful try flushing the tube with fizzy soda water, and leave in place for 30 minutes
  • when the blockage has been freed, flush the tube with warm water using a push / pause technique
  • if the tube is unable to be unblocked refer to Nutrition Nurse Specialist or PEG Link Nurse
  • always inform a doctor or Nutritional Nurse Specialist prior to further action being taken

Reference:

• 1) Darlington NHS Trust (February 2009). Care of Percutaneous endoscopic gastrostomy Tubes (P.E.G.) in the community.