Clinical Practice Guidelines for the Nursing Management of Percutaneous Endoscopic Gastrostomy and Jejunostomy (PEG/PEJ) in Adult Patients

Roveron, Gabriele; Antonini, Mario; Barbierato, Maria; Calandrino, Vita; Canese, Giancarlo; Chiurazzi, Lucio Fernando; Coniglio, Gesualdo; Gentini, G.P.; Marchetti, Mara; Minucci, Andrea; Nembrini, Laura; Neri, Vanessa; Trovato, Paola; Ferrara, Francesco

doi:10.1097/won.0000000000000442

Cited by 29 publications

(47 citation statements)

References 47 publications

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“…Balloon-type replacement tubes are mostly used for blind replacement. If a first tube change can be planned, it is recommended to perform it in a hospital, and afterwards replacement may be completed in a home care setting or nursing home by a nurse, if patients are not able to perform it [55].…”

Section: Commentarymentioning

confidence: 99%

“…If no commercially available gastrostomy tube with similar diameter is available for immediate replacement, a balloon-tipped Foley catheter of the same size can be used temporarily to keep the tract open and, if necessary, to administer EN, fluids or medications, although this is currently more difficult with universal safety connectors (e.g. "ENFit ® ") [55]. If there is any doubt of malposition after blind replacement then endoscopic or radiologic confirmation of correct position using a water-soluble contrast should be carried out prior to use of the tube.…”

Section: Commentarymentioning

confidence: 99%

“…A sterile Y dressing to compress (that does not shed fibers), placed under the external disc plate, is commonly used, followed by a skin friendly and solvent-free breathable dressing. When the dressing is placed under the exterior bumper, tension has to be avoided [55,57]. Occlusive dressings should be avoided because they promote a moist wound environment and can lead to skin maceration [56,57].…”

Section: How Should the Tubes The Tube Insertions Sites And Consumabmentioning

confidence: 99%

“…Commentary to recommendations 20 and 21 A small peristomal liquid drainage in the week after placement can occur, but leakage of gastric content (very often in combination with signs of peristomal infection or gastrostomy tract enlargement) can lead to serious problems and even tube loss. Risk factors for peristomal leakage include skin infection, increased gastric acid secretion, gastroparesis, increased abdominal pressure, constipation, side torsion of the tube (which leads to ulceration and enlargement of the tract), increased tension between the internal and external bolster, BBS and the presence of granuloma tissue in the tract [55,66,67]. Also, patient-related factors can hinder wound healing such as diabetes (hyperglycemia), immunosuppression and malnutrition.…”

Section: Grade Of Recommendation Gpp E Strong Consensus (92% Agreement)mentioning

confidence: 99%

“…If local infection or excessive granulation tissue are present, this should be properly managed (see also Recommendations 22 and 24). Replacing the tube with a larger-diameter tube seems to be not very effective and can result in an enlarged stoma tract with more leakage [55]. In some refractory cases it can be tried to remove the tube for 24e48 hours, which permits slight spontaneously closure of the tract aiming that the replacement tube will fit more closely [70].…”

Section: Grade Of Recommendation Gpp E Strong Consensus (92% Agreement)mentioning

confidence: 99%

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ESPEN guideline on home enteral nutrition

et al. 2020

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This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers about the indications and contraindications for HEN, and its implementation and monitoring. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. This guideline will also inform interested patients requiring HEN. The guideline is based on current evidence and expert opinion and consists of 61 recommendations that address the indications for HEN, relevant access devices and their use, the products recommended, the monitoring and criteria for termination of HEN, and the structural requirements needed to perform HEN. We searched for metaanalyses, systematic reviews and single clinical trials based on clinical questions according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing the SIGN method. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN.

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Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

Section: How Should the Tubes The Tube Insertions Sites And Consumabmentioning

confidence: 99%

Section: Grade Of Recommendation Gpp E Strong Consensus (92% Agreement)mentioning

confidence: 99%

Section: Grade Of Recommendation Gpp E Strong Consensus (92% Agreement)mentioning

confidence: 99%

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ESPEN guideline on home enteral nutrition

et al. 2020

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Comparison of normal saline and antiseptic solution effect on the early peristomal infection rates of patients with percutaneous endoscopic gastrostomy tubes: A randomized double‐blind study

et al. 2023

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BackgroundThis study's aim was to compare the efficacy of normal saline (NS) with that of antiseptic solution in early peristomal skin care after percutaneous endoscopic gastrostomy placement in terms of peristomal infection incidence.MethodsThis was a randomized controlled double‐blind study conducted at a university hospital between December 2019 and April 2021. All patients who underwent percutaneous endoscopic gastrostomy and met the inclusion and exclusion criteria were included in the study. The study population consisted of 64 patients randomized to group 1: NS (n = 31) and group 2: 0.1% polyhexamethylene biguanide and 0.1% betaine (PHMB‐B; n = 33). Daily peristomal skin care was performed for 7 days, starting 24 h after insertion. Peristomal skin was evaluated by two blinded investigators before each dressing, and findings were recorded. Data analysis was performed with descriptive statistics; chi‐square analysis; and exact, Shapiro‐Wilk, Mann‐Whitney U, and Cochran Q tests.ResultsThere was no statistically significant difference between the groups in terms of peristomal infection rates (group 1: 12.9%, group 2: 9.07%; P > 0.05). Redness increased from day 4 in group 1 and day 5 in group 2, and exudate increased from day 5 in both groups. There is a statistical difference in the number of patients between the days when redness and exudate appear and increase.ConclusionBoth NS and PHMB‐B solutions can be preferred in peristomal care. However, NS may be the first choice for early peristomal care that does not show signs of infection, because it is not irritating and allergic and is cost‐effective.

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