TECHNIQUE OF PERCUTANEOUS RESCUE PEG PLACEMENT AFTER ACCIDENTAL DISLOCATION

Aims Accidental dislocation of PEG tubes frequently occurs in patients with balloon type PEG tubes. Dislocation may have crucial impact in case of supplementation of nutrition and medication. Unfortunately a simple reinsertion of a new PEG tube is frequently not achievable because of shrinking of the transabdominal orifice which can occur within hours. In addition placement of a new PEG may be altered in some individuals by changed anatomy or tumor progression.

We aimed to describe a simple and safe standardized method for the reinsertion of a PEG tube after dislocation.

Methods Retrospective single center analysis of treatment data of patients suffering from PEG dislocation who were treated with the following reinsertion technique.

After skin disinfection a wire is inserted into the ostium. In case of passage, the Abdominal wall around the orifice is anesthetized. Using a commercial available set for PEG placement with direct puncture (Cook Medical) the tract is then dilated in steps of 16 CH and 18 CH followed by insertion of a 18 CH peel away sheath. Through this sheath, a 16 CH PEG (Entuit Thrive, Cook Medical) is inserted and the balloon is blocked. All necessary supplies are sterile and included in the set. Antibiotic prophylaxis was not given.

Results In total 18 patients were treated as described. The time from dislocation until reinsertion was between 1 and 8 days. In all cases the stomach could be cannulated and all treatments were successful. Complications did not occur. In one case the method was successfully used to reinsert a jejunal feeding tube on ICU.

Conclusions The described technique is safe and simple to use for reinsertion of PEG tubes after dislocation. The system is certified and offers sterile working and as an advantage towards individual solutions for the situation of PEG dislocation.