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Problematic PEG Tubes

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Problematic PEG Tubes

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    1. Problematic PEG Tubes Rosie Smyth Royal Group of Hospitals

    3. Early detection is essential Delayed healing Increased mortality & morbidity Increased LOS Missed opportunity

    4. It is important to recognize that not all problems with PEG tubes are device related.

    5. Type of problems Recurrent site infections Leakage Granulomas Displacement Migration

    6. Recurrent site infections Important to review patients nutritional status including micronutrient screen Antibiotics are not always the answer Work with the site Look for other relating factors

    7. Leakage

    8. Scenario 75 year old lady suffering from Alzheimer's & Downs Syndrome. Admitted to hospital with vomiting, dehydration. Gastrostomy fed for several years. Being cared for in a nursing home. Asked to see her because of excoriated skin surrounding gastrostomy

    9. What to do? First concern was skin integrity Position & integrity of device Securing gastrostomy Look for other causes Establishing feeding regime ASAP

    10. If leakage continues to be a problem look at other relating issues: Gut function i.e. constipation, diarrhoea delayed gastric emptying May need to reduce feeding rate Look at new treatments i.e. Antisecretory or motility drugs if appropriate May need to convert to LPG or Gastrojejunostomy

    11. Granulomas Treat with silver nitrate or silver impregnated dressings Surgical debribement may be necessary

    12. Granulomas

    13. Displacement If displaced it is important to keep tract open If displaced within the first 3 weeks must be treated as an emergency Replace with Gastrostomy OR LPGD ASAP Have a replacement tube on site

    14. Displacement If continually displacing use a tube attachment device. Change every 4-5 days Insert LPGD

    15. Migration Can cause vomiting & possible obstruction Check the position of the tube in relation to external markings Check volume of water in balloon. May need to reduce this Secure device with tube attachment device

    16. Any questions?

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