Emergency Presentations for Gastrostomy Complications Are Similar in Adults and Children

Abstract

Gastrostomy tube (GT) complications are often managed in the Emergency Department (ED). We aimed to characterize and compare the pattern of ED presentations of GT complications in adults and children. A retrospective chart review of patients with GT complications presenting to 3 Australian EDs in 2 years was undertaken. ED visits for GT complications occurred in 70 GT patients (36 adults, 34 children) with 122 presentations. When comparing adults to children, infections occurred in 21% versus 36%, respectively; P = 0.08, mechanical issues in 48% versus 52%; P = 0.86, vomiting in 23% versus 8%; P = 0.02, and other issues in 7% versus 5%; P = 0.7. Presentation to ED within 28 days of initial GT insertion occurred in 3 (8%) adults and 3 (9%) children, predominantly with tube dislodgement. GT complications seen in ED are predominantly infectious and mechanical in nature, with an increased frequency of vomiting in adults when compared with children.

Assessment of the effect of colored beverage on gastric returns after gastric tube replacement to enhance placement verification

“…More focus on evidence‐based standards and guidelines for G tube replacement is called for as these tubes are used with increased frequency. Algorithms for providing consistent care for pediatric patients have been suggested 42 and the benefit of utilizing dedicated G tube services has been suggested 10 . Results from this project will be shared with appropriate professional organizations to promote guideline development.…”

“…Algorithms for providing consistent care for pediatric patients have been suggested 42 and the benefit of utilizing dedicated G tube services has been suggested. 10 Results from this project will be shared with appropriate professional organizations to promote guideline development. For example, it is consistent with suggestions for future research by the American Society of Parenteral and Enteral Nutrition (ASPEN) Safe Practices for Enteral Nutrition Therapy 3 to explore nonradiologic methods of confirming tube position as well as promoting optimal PEG and balloon tube replacement protocols.…”

“…8 In a study of pediatric patients, 119 of 159 G tube-related ED visits were for displacement or 1.25 mean ED visits per patient per year 9 and G tube complications have been reported to be similar between adults and children. 10 Percutaneous endoscopic gastrostomy (PEG) type tube dislodgement rates of 36% within a year of followup have been reported. 11 Dislodgement after the initial postinsertion period is underreported and underappreciated according to a retrospective review, suggesting a need for increased tube replacement, thus taxing healthcare resources.…”

“…A secondary analysis of the Minimum Data Set merged onto Medicare Claim Files revealed that 53.6 of 1000 nursing home residents received G tubes within 1 year of follow‐up, and of these, 19.3% required replacement or repositioning within a median of 145 days from initial placement 8 . In a study of pediatric patients, 119 of 159 G tube–related ED visits were for displacement or 1.25 mean ED visits per patient per year 9 and G tube complications have been reported to be similar between adults and children 10 . Percutaneous endoscopic gastrostomy (PEG) type tube dislodgement rates of 36% within a year of follow‐up have been reported 11 .…”

Troubleshooting the pediatric gastrostomy

“…It follows then that both prevention and effective countermeasures for complications offer to relieve pain and disutility for patients, while also reducing costs and sparing tight resources. Although many papers have appeared in the literature reviewing tube-related troubles, [1][2][3] none seem to offer frontline clinicians a practical playbook for managing these problems. Instead, mismanagement generated by widespread misunderstandings of tubes and tube complications remains endemic.…”