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Tuesday, 7 March 2017

PEG Feeding and Nutrition

Percutaneous endoscopic gastrostomy (PEG) is an endoscopic medical procedure in which a tube (PEG tube) is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate (for example, because of dysphagia or sedation).

So, in laymen’s terms A PEG tube is a feeding tube which passes through the abdominal wall into the stomach so that feed, water and medication can be given without swallowing.
diagran showing the Percutaneous endoscopic gastrostomy (PEG)
So why then does this means of nutrition and hydration seem to fill relatives with fear and concern?

Why, are there so many complications with a PEG?

In the elderly, there is a high risk for malnutrition. With advancing age, there is an increased chance for developing diseases or conditions that affect nutrition. Cognitive impairments can also cause chewing and swallowing difficulty. According to the Dietetic Association, nutritional status is one of the most important contributors to self-sufficiency, disease recovery and quality of life in the elderly.

A feeding tube may greatly benefit health status when oral feeding is no longer possible, but is a last resort not an “easy way out”. There are dangers of using feeding tubes in the elderly, and monitoring for malnutrition is required, as the tube cannot be relied upon as the sole supplier. Nausea, vomiting and diarrhoea can all be side effects from tube feeding.

The concentration of the formula, the rate of flow and the amount of water provided affect people differently, which is why doctors will initiate feedings at a slow rate and increase until the goal rate is reached. In the severely malnourished elderly, precautions should be taken against refeeding syndrome. This occurs when nutrition is repleted suddenly in starved individuals. It can cause high blood sugar, heart complications and death.

Although a tube feed can be placed nasally or orally for short periods, a gastrostomy is the surgical procedure in which a permanent feeding tube, known as a PEG tube, is inserted into the stomach. The tube site is a wound that is prone to infection and must be kept clean.

Even with the best care infection is still possible to the site, as the elderly tend to have a weakened immune system. Recovering from an infection can be further compromised if nutritional status is impaired, which is common in this age group. Excessive bleeding at the site may also occur until fully healed. The surgical site should be routinely checked for any drainage, blockages, or pain.

There comes with tube feeding psychological effects, which may impact on an elderly individual.  Imagine never being able to taste food or to go out for a meal with friends.  Those on a PEG feed may also miss the pleasure of taste and the socialisation of eating meals with friends and family. It is important for tube feeders to have socialisation in other ways to prevent depression. Those with cognitive impairments such as dementia may require restraints to prevent them from pulling out their tube. This can cause distress to not only the patient but be difficult on family members as well.

Also, where possible fluids should be put through overnight, meaning that during the day people can go to activities, the communal lounge or outside. Caution should also be used so care homes don't see these devices as saving on carers time having to feed 3 meals a day.

There is also the added complication of Aspiration, this is the unintentional inhalation of food or fluids into the lungs. It is dangerous in the elderly because of the risk of aspiration pneumonia. Although a tube feeder may not be consuming food orally, they are still at risk for aspirating the enteral formula. Lying flat while receiving a tube feed, or receiving an excessive amount of formula in a short period of time should be avoided. Appropriate precautions should also be taken with the elderly who suffer from oesophageal reflux.
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