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Early initiation of enteral feeding after percutaneous endoscopic gastrostomy tube placement
Srinivasan Dubagunta1, Christopher D Still, Arvind Kumar
1Department of Gastroenterology/Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.
Insights
Early initiation of enteral feeding via percutaneous endoscopic gastrostomy (PEG) tubes, starting just 4 hours after placement, is safe and effective. This approach reduces hospital stays and costs, demonstrating significant benefits for patients receiving nutritional support.
Area of Science:
- Gastroenterology
- Clinical Nutrition
- Medical Devices
Background:
- Enteral feeding via percutaneous endoscopic gastrostomy (PEG) tubes is crucial for nutritional support.
- Delayed initiation of feeding post-PEG placement is common practice, despite evidence suggesting earlier feeding is beneficial.
- Current practices often lead to prolonged hospital stays and increased healthcare costs.
Purpose of the Study:
- To evaluate the efficacy and safety of a protocol for initiating enteral nutrition 4 hours after PEG tube insertion.
- To assess the feasibility of same-day discharge for outpatients undergoing PEG placement with early feeding.
- To determine the potential for cost savings through early feeding and reduced hospitalization.
Main Methods:
- A prospective study enrolled 77 patients undergoing PEG tube placement for enteral feeding.
- Patients were evaluated 4 hours post-insertion, including vital signs and abdominal examination.
- Enteral feedings were initiated 4 hours post-insertion, with patients followed for 30 days to monitor complications.
Main Results:
- Early initiation of PEG feeding was successfully implemented in 77 patients.
- The most common finding during post-insertion evaluation was minimal tenderness around the PEG site.
- Complications included one case of aspiration pneumonia (1.3%) and one death attributed to underlying disease.
Conclusions:
- A systematic protocol for early enteral feeding initiation (4 hours post-PEG) is safe and effective.
- This approach can lead to significant cost savings by reducing the need for inpatient hospitalization.
- Early feeding protocols optimize patient care and resource utilization in nutritional support.
Abstract:
Enteral feeding through the percutaneous endoscopic gastrostomy (PEG) tube is usually initiated about 12 to 24 hours after insertion of the tube. There have been earlier studies evaluating the efficacy of early initiation of enteral feedings that had encouraging results. However, delayed initiation of feeding following PEG placement continues to be practiced widely. We believe that feeding can be done earlier without any increase in associated morbidity or mortality and with obvious reduction in the need for parenteral nutrition and healthcare costs. We evaluated a protocol to initiate enteral nutrition 4 hours after the PEG tube insertion with subsequent discharge of the outpatients on the same day. We conducted a prospective study to assess the efficacy of early initiation of PEG feeding. We enrolled 77 patients in our study who were having PEG tubes placed for enteral feeding. Only patients who had a PEG placed for gastric venting procedures were excluded from our study. During the course of our study, no patient had to be excluded for the latter reason. Patients were evaluated by the physician performing the procedure, 4 hours after the tube was inserted. Their vital signs were checked, and a thorough abdominal examination was performed. Minimal tenderness around the PEG site was the most frequent finding. Otherwise, all the patients had a benign abdominal examination. The tube was flushed with 60 mL of sterile water. Following the examination, orders were given to restart the feedings. These patients were followed for a 30-day period to evaluate complications associated with PEG tube placement and early initiation of PEG feeding. There was one case of aspiration pneumonia (1.3%) and one death that was attributed to the underlying disease out of our 77 patients. Early initiation of enteral feeding after PEG tube placement can be successfully completed with a systematic protocol and close observation. Not only was this protocol found to be safe, it can also have significant cost savings by eliminating the need for inpatient hospitalization for the procedure.
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