The prevention and management of complications associated with established percutaneous gastrostomy tubes in adults: a systematic review

Abstract

Objective: This systematic review aimed to summarise the best available evidence relating to the prevention and management of complications associated with established percutaneous gastrostomy tubes in adults. Inclusion criteria: This review considered studies investigating the effectiveness of strategies to prevent and/or manage complications associated with established percutaneous gastrostomy (PEG) tubes in adults where care was provided in the hospital, aged care or community setting. Complications included PEG stoma site infection, occlusion, site excoriation and inadvertent removal. Search strategy: The search strategy aimed to find published and unpublished studies and was limited to reports published in the English language. Reference lists of studies that met the inclusion criteria were searched for additional studies. Company representatives were also contacted for information about ongoing or unpublished studies. Methodological quality: Study reports selected for retrieval were assessed by two independent reviewers for methodological quality prior to inclusion in the review using a critical appraisal instrument developed specifically for this review. Results: There were 40 studies that met the inclusion criteria for this review. Thirty-five were excluded after critical appraisal. The five remaining studies contained information regarding strategies for the prevention and/or management of site infection, occlusion and inadvertent removal. There were no studies include that addressed excoriation at the stoma site. Reported strategies for the prevention of complications included regular follow-up, the provision of pre discharge instructions and programmed tube changes. Strategies reported for the management of site infection included local antibiotic therapy, skin care and intravenous antibiotic therapy. Reported interventions for the management of occlusion included the use of enzymes, guidewires, flushing, replacement and removal. The only intervention reported for the management of inadvertent removal was replacement. Conclusion: The research regarding the prevention and management of complications associated with PEG tubes is sparse and potentially of poor quality. Interventions are often poorly described and few comparative studies are published. While few recommendations for practice can be made a range of recommendations for future research are provided. There is an urgent need for further research examining many aspects of the prevention and management of complications associated with PEG tubes