A Percutaneous Endoscopic Gastrostomy (PEG) tube is a flexible feeding device inserted through the abdominal wall directly into the stomach to provide nutrition, fluids, and medication. Accidental dislodgement of this tube is a relatively common occurrence and constitutes an urgent medical situation. Immediate and correct action is required because the tract, or stoma, connecting the stomach to the outside can begin to close rapidly once the tube is removed. Understanding the proper response to this accident is essential for the patient’s well-being and to prevent serious complications.
Immediate Steps Following Dislodgement
The initial response to a dislodged PEG tube should be a calm assessment of the situation and immediate site management. If the tube has not completely come out, gently remove it fully to prevent further damage to the stoma tract. Check the site for any active bleeding; if minor bleeding is present, apply gentle pressure with a clean piece of gauze.
After controlling any bleeding, the area around the stoma needs to be cleaned thoroughly to prevent infection. Use mild soap and water or a saline solution to gently cleanse the skin surrounding the opening. This ensures the site is free of gastric contents, which can irritate the skin and introduce bacteria.
Once the area is clean, cover the stoma with a sterile or clean, dry dressing, such as gauze, and secure it with medical tape. This dressing protects the open wound from contamination. Note the exact time of the dislodgement, as this information is needed by the healthcare provider to determine the urgency of the next steps.
Understanding the Risk of Stoma Closure
The most pressing concern following PEG tube dislodgement is the rapid closure of the gastrocutaneous fistula, or stoma. This tract connects the stomach and the abdominal skin and can begin to contract and narrow quickly, sometimes starting to close within four to six hours. If the tract fully closes, usually within 24 hours in a mature stoma, a new tube cannot be reinserted at the bedside.
For tracts less than four weeks old, known as immature stomas, the risk is higher, and reinsertion should not be attempted by a layperson due to the possibility of misplacement into the abdominal cavity. If the tract is mature, a healthcare provider may temporarily insert a Foley catheter to maintain the patency of the opening until the correct PEG tube can be secured. This temporary measure is purely to keep the channel open and should only be performed under the instruction of a medical professional. Never attempt to force a tube into the stoma, as this can cause trauma and create a false passage.
When to Seek Emergency Medical Care
Contacting the healthcare provider or emergency services is necessary as soon as the tube is dislodged, but certain signs require immediate emergency medical care. Any indication of peritonitis, which is the inflammation of the abdominal lining, warrants urgent attention. Symptoms include severe, worsening abdominal pain, rigidity of the abdomen, or signs of septic shock.
Immediate medical assessment is required for signs of infection, such as fever above 100.4°F, increased redness, warmth, swelling, or pus draining from the stoma site. The patient should also be taken to the nearest emergency department if there is significant or continuous bleeding that does not stop with light pressure, or if stomach contents are visibly leaking around the stoma. Never attempt to feed through a reinserted tube until its proper placement is confirmed by a medical professional through aspiration or imaging.
Routine Care to Prevent Accidental Removal
Preventing accidental dislodgement involves consistent daily maintenance of the PEG tube and the surrounding area. The tube should be secured to the skin at all times using a dedicated attachment device or medical tape to reduce tension and movement. Leaving a small amount of slack in the tube, rather than pulling it tight against the skin, helps prevent accidental traction.
Regularly checking the tube’s position and the external bumper is important for prevention. The external bolster should sit loosely against the skin, allowing for movement and cleaning underneath, but not so loose that the tube can migrate significantly. Proper cleaning of the stoma site with soap and water and ensuring the area is dry helps prevent skin irritation. For patients prone to pulling at the device, using an abdominal binder or a decoupling device can be an effective strategy to keep the tube secure.