Enteral Feeding Tubes

5 Common PEG Tube Complications & Their Prevention

PEG tube complications can be attributed to how a peg tube is inserted or removed. While these are generally safe and effective, it's important to be aware of feeding tube complications.   

A PEG or percutaneous endoscopic gastrostomy tube is a device inserted into the stomach via the abdominal wall to provide nutrition and medications to patients who cannot take them orally. Like any medical device, a feeding tube in stomach can sometimes cause problems.  

Many g-tube problems are preventable with due diligence and proper hygiene measures. While the more complicated issues may require immediate medical attention.   

Here are the PEG tube problems and how to prevent them.  

5 Common PEG Tube Complications  

Complication #1. What if the PEG tube is clogged or blocked?  

One of the major reasons for a clogged peg tube is the buildup of formula or medications. Flushing the tube may solve the issue. However, the blockage can also result from fungal growth in the tube. In such cases, the tube must be replaced.   

As a precaution, general practitioners prescribe medicines in liquid or dispersible tablet form to minimize the risk of blockages.  

When should you flush the feeding tube?  

You should flush the feeding tube before and after every feeding and medication session.   

Even when you're not using the tube for feeding, it's a good idea to flush it with water once daily to keep it clear. Your dietitian will tell you how much water to use and when to flush. Your doctor might suggest more frequent flushes if needed.  

What to do if the feeding tube is blocked?   

To unclog the G-tube -   

1. Milk the tube: Gently squeeze and roll the tube between your thumb and forefinger along its length until it is unclogged.  
2. Push and pull technique: Fill a 60ml syringe with cooled boiled water (boiled then cooled for 20-30 minutes before being used). Connect it to the tube. Push and pull the syringe and try to loosen the blockage. It might take up to 30 minutes to clear the tube. Be gentle; don't push too hard to avoid damaging it.  
3. Soda Water: If the blockage persists, try flushing the tube with soda water. Let it sit for half an hour to help dissolve the blockage. Then, use the push-pull technique to rinse the tube. Avoid flushing with sugary drinks like cola or lemonade. These drinks can worsen clogging and cause the tube to break down.  
4. Submerge in warm water: Immerse the blocked portion of the external tubing in a bowl of warm water for about 10 minutes. It can soften the blockage and make the methods above work better.  

If none of these methods work for unclogging the tube, here is what you should do -   

• Reach out to the manufacturers for further guidance.  
• Consult with your dietician or medical practitioner.  

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Complication #2. What to do if a feeding tube is infected?  

Infections around the tube site are a common feeding tube complication resulting from poor hygiene, contaminated feeding supplies, skin conditions, improper insertion, compromised immune systems, stagnant feed, or any underlying health conditions.   

What are the signs of g tube infection   

Peg tube infection is characterized by the following -   

• Redness and swelling: If you notice the skin around the tube site is red, swollen, or inflamed, it could be a sign of infection.  
• Warmth and tenderness: If the area feels warm or tender when you press on it, it might be due to an infection.  
• Pain or discomfort: Persistent pain or discomfort around the tube site could suggest an infection.  
• Discharge: Any unusual discharge from the tube site, such as pus or fluid, may indicate an infection.  
• Foul odor: An unpleasant odor around the tube site could indicate infection.  
• Fever and chills: Uneasiness, fever, and chilliness may indicate infection.  
• Change in appearance: Any sudden change in the appearance of the site, such as increased redness or swelling, should be monitored closely.  

How do you treat an infected PEG tube? 

Infections around the g-tube can lead to serious consequences if not treated on time. Here is what you can do -   

• Seek medical attention: Consult your doctor immediately if you see any signs. They will assess your situation and recommend the necessary treatment.  
• Maintain hygiene: Proper hygiene helps prevent the infection from worsening. Wash your hands before touching the feed tube. Keep the area around the tube site clean and dry. Follow any cleaning instructions given by your healthcare provider.   
• Do not remove the tube: Unless instructed by your doctor, do not attempt to remove the tube. It could exacerbate the infection and worsen the situation.  
• Administer broad-spectrum antibiotics: Your doctor will likely prescribe antibiotics for enteral or oral administration and topical hydrocortisone cream to soothe the area. They may also prescribe other treatments based on the severity of the infection.   
• Monitor your condition: Pay attention to how the body responds to treatment. If the treatment does not help your situation, contact your doctor again for further assessment.  

Infections can be serious; hence, involving a medical professional as early as possible is crucial to prevent further peg tube complications.  

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Complication #3. What happens when a feeding tube leaks?  

In the initial days after peg tube placement in stomach, it's normal for a slight discharge of thin, yellow-green fluid to stick to the tube.   

Some stomach contents, water, or formula leakage from the stoma is common, but excessive leakage can lead to skin problems, a larger stoma, and discomfort.  

Reasons for the leakage include tube movement, excessive tissue growth, tube damage, infection, and stomach pressure issues. You can prevent leaking peg tubes by limiting the stoma movement and keeping the stoma site hygienic.  

What to do if the peg tube leaks?  

Leakages around a feeding tube are common for most individuals. In many cases, using an absorbent wound dressing and a barrier cream around the stoma can effectively absorb moisture and prevent additional problems.   

However, if the leakage is still persistent or coupled with abdominal pain, contact a doctor for further evaluation and assistance.  

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Complication #4: What happens if a PEG tube is accidentally pulled out?  

According to a study by the National Library Of Medicine, accidental dislodgement or removal of the tube is a common peg tube complication. It is often seen in neurologically impaired patients.     

Early dislodgement can happen within 7-14 days of placing the feeding tube before the stomach opening fully matures. Consult your doctor immediately if the tube dislodges.   

It's essential to take precautions, especially in patients with recent surgeries. Properly securing and monitoring the tube can help prevent the peg tube from dislodging accidentally.   

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Complication #5: What to do if the person with a feeding tube aspirates?  

Aspiration occurs when the food or liquid enters the airway instead of the esophagus. It can happen during tube feeding or be a PEG tube removal side effect.  

The risk of aspiration increases for those with dysphagia, as the food might get stuck in the throat and enter the airway. Aspiration can lead to respiratory infections, pneumonia, and other health issues.  

What are the signs of aspiration  

• coughing  
• choking  
• gagging  
• throat clearing  
• vomiting.   

If these symptoms arise, consider halting the feeding and contact your doctor.  

How do you prevent aspiration with a PEG tube?  

1. To prevent aspiration, pace your feedings -   

• Infuse no more than 360 mL of formula for over 15 minutes for bolus tube feeding.  
• Infuse no more than 480 mL for over 30 minutes for gravity tube feeding.  
• Don't exceed 150 mL per hour through the feeding pump when tube feeding into the small intestine.  

1. Sit upright during tube feeding, if feasible.   
2. If tube feeding in bed, use a wedge pillow to elevate your upper body.   
3. Stay upright (at least 45 degrees) for an hour after finishing tube feeding.  

These precautions and guidelines can significantly lower the risk of aspiration and its potential complications.  

Remember, following your healthcare provider's instructions and guidelines for managing PEG tube complications is essential. To deal with PEG tube complications, contact your healthcare professional for proper treatment.   

PEG Tube Supplies That Can Help!

 

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