PEG tube dislodgement

Q: 74 years old patient with recent CVA is status post percutaneous endoscopic gastrostomy (PEG) tube placement one week ago. Patient became delirious and pulled his PEG tube. Intensivist was called at the bed side within 5 minutes. PEG tube can be safely put back through the stoma while it is patent? 

 A) Yes 

 B) No

Answer: B

For safety and protection, most PEG tubes are designed in a way that they can sustain about 10-14 pounds of external pull pressure. Said that it is a common scenario in hospitalized patients to have PEG tube dislodged accidentally. PEG tract usually matured by week 4. Prior to that it is not a good idea to blindly re-insert the PEG tube through immature gastric tract. 

This is due to the fact that the gastric wall and the abdominal wall may have separated, and blindly inserted PEG tube may end up in peritoneal cavity. GI or surgical service should be called back. Alternatively, a contrast study should be performed to confirm the proper position of the reinserted tube. 

If the tract is matured, there should not be a delay to insert replacement tube (or keep it patent with any tube such as Foley catheter). Mature tract may close within few hours.

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References:

1. Cmorej P, Mayuiers M, Sugawa C. Management of early PEG tube dislodgement: simultaneous endoscopic closure of gastric wall defect and PEG replacement. BMJ Case Rep. 2019 Sep 4;12(9):e230728. doi: 10.1136/bcr-2019-230728. PMID: 31488448; PMCID: PMC6731818.

2. Shah R, Shah M, Aleem A. Gastrostomy Tube Replacement. [Updated 2021 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482422/