Damaged PEG tube - when to replace?

[Murse901, MSN, RN]

A friend of mine who works LTC texted me today when she discovered that a PEG tube had blown out while she was attempting to clear a plug in the tube. I'm not sure exactly what she did wrong, if she even did anything wrong, to blow the tube out. In any case, she told me that there was a large hole about 1 inch down from the access port and she asked me what my recommendation was.

I told her that the tube needs to either be replaced by an RN who is trained to replace PEGs or that the patient needs to be sent out for a replacement.

She called the FNP on-call, and the FNP told her to just cut below the hole, remove the access port from the damaged part of the tube, and place the access port back on the now-shorter tube.

What do you guys think? Are you comfortable doing that type of procedure - jury-rigging a medical device - or would you insist that the PEG is replaced? My chief concern would be that the PEG is possibly damaged at a secondary location in the perioneum that is not immediately visible, because something is clearly wrong with the PEG in that it failed by blowing out.

Is it overly-cautious to insist that the PEG be replaced, or is it acceptable to modify the device in the way that the FNP advised?

[Salisburysteak, BSN, RN]

I have done exactly that if there is a hole in the PEG. That can be a temporary fix. I would definitely look into replacing the PEG since they are sewn in. I did not know that RNs can replace PEG tubes. I have replaced g-tubes as a LPN.

[Asystole RN]

Things that are broken need to be fixed or replaced.

The only things that can be fixed are the devices that are identified in policy that they can be fixed and only fixed by those repairs kits that are FDA 510k cleared to do so.

Very few things should be fixed, most should be replaced. A single area of damage usually denotes a systemic degradation of the material. A hole where visible is a sign, many times, that a hole(s) may be where they cannot be seen. Considering the life-threatening nature of infusing into the peritoneal cavity and the relatively high mortality rate of doing so, I would say prudence may be called for.

[caliotter3]

Based on the information given, I would notify the doctor and let him make the decision. Nurses are not allowed to replace PEG tubes where I work, only G-tubes, if there is an order allowing it.

[Murse901, MSN, RN]

Thanks for the replies. Sorry about the confusion between PEG and G-tubes. I have a tendency to call everything a PEG tube, even if it's a J-tube. In this case, it was a G-tube and did not require suturing.

I got an update that night from my LPN friend. She said that the FNP told her to just do the procedure (cut it off and replace the port in the newly-cut section) and that the FNP would be there in the morning to replace the tube.

Red flag - the FNP knows that the tube needs to be replaced, but tells the LPN to continue using it. Obviously, the FNP knows that there is a problem that needs to be corrected, but thinks that it's okay to continue using this tube.

One more reason to stay away from nursing homes if you value your nursing license.