Nurse-led service for children with gastrostomies: a 2-year review
Percutaneous endoscopic gastrostomy (PEG) feeding can provide long-term nutritional support for patients with a functional gastrointestinal system but insufficient oral intake. Some patients, however, may require jejunal feeding, which can be achieved using a PEG tube with jejunal extension (PEG-J). A previous review at a tertiary paediatric hospital revealed poor documentation and a high incidence of buried bumper syndrome (BBS) in children with gastrostomies. Subsequently, a nurse-led service for gastrostomy care was introduced.
To determine the impact of the nurse-led service.
Prospective review, at 1 year and 2 years, following either a PEG or PEG-J insertion. Patient records were reviewed and a telephone survey was conducted. Statistical analysis was performed using Fisher's exact test.
32 PEG and 6 PEG-J patients were included in this study. There was 100% documentation of provision of care instructions. Average satisfaction with the service was over 8/10. Incidence of BBS was 0% in the PEG group and 17% in the PEG-J group. Of those parents/carers surveyed, 74% wanted additional tube care support via SMS text message.
Introduction of a nurse-led service resulted in complete documentation of provision of care and sustained high levels of parental satisfaction. Future care should focus on utilising technological platforms.
Percutaneous endoscopic gastrostomy (PEG) feeding is a valuable option for patients with a functional gastrointestinal (GI) tract who require long-term nutritional support but have insufficient oral intake (Blumenstein et al, 2014). In addition, some patients may require jejunal tube feeding to provide postpyloric feeding, which can be achieved using a PEG tube with jejunal extension (PEG-J) (Fröhlich et al, 2010; Kwon et al, 2010).
Although commonly performed, PEG is a surgical procedure with high rates of complications up to 51.5% reported in paediatric populations (Khattak et al, 1998; El-Matary, 2008; Park et al, 2011; Hansen et al, 2017; Balogh et al, 2019). Minor complications include granuloma formation, wound infection, blocked tubes and dislodged tubes. Major complications include colonic fistula, necrotising fasciitis, bleeding, volvulus, tumour seeding and buried bumper syndrome (BBS) (El-Matary, 2008; Hucl and Spicak, 2016).
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