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Care and Long-Term Maintenance of Percutaneous Endoscopic Gastrostomy Tubes

Stephen A. McClave, MD^*, and Rita L. Neff, RN

From the ^* Department of Medicine, University of Louisville School of Medicine, and Kindred Hospital, Louisville, Kentucky

Correspondence: Stephen A. McClave, MD, Professor of Medicine, Division of Gastroenterology/Hepatology, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY 40202. Electronic mail may be sent to samcclave{at}louisville.edu.

Placement of a percutaneous endoscopic gastrostomy (PEG) tube creates a controlled perforation of a hollow viscous organ and an acute surgical wound. Physicians who place PEG tubes endoscopically or fluoroscopically often do not have the opportunity to provide these patients with long-term follow-up care. Thus, nutrition support specialists who do treat these patients may be the one member of the health care team who is in the most advantageous position for ongoing inspection and maintenance of the access device. Carefully monitored surveillance and adherence to routine principles of wound care assure the health of the skin, the underlying tissue, and the tract into the abdominal cavity through which the PEG passes. Having knowledge of the types of tubes placed, performing a regular physical examination of the PEG site, and maintaining good communication with the endoscopist results in early identification of problems, promotes rapid simple strategies to correct deficiencies, and the opportunity to minimize long-term complications. Dietitians, wound-care ostomy nurses, and other nutrition support specialists are encouraged to be more proactive with their participation in the care and management of the PEG site.

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