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Quick Tip for Families in Intensive Care: American Journal of Medicine Confirmed: Nasogastric Tubes are Safer Than PEG (Percutaneous Endoscopic Gastrostomy) Tubes

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

Today, I want to talk, again, about, “Nasogastric tube versus PEG (Percutaneous Endoscopic Gastrostomy) tubes in ICU.” Why you should avoid PEG tubes, generally speaking? Once again, there are exceptions to the rules when the PEG tube is absolutely the right thing to do. But more often than not, it is not the right thing to do.

So, let me explain. I’ve been talking for many years here on my videos, on my podcast and on my blogs about that as a family in intensive care, you should think twice, three times, four times, five times about that you want to give consent to a PEG tube or whether you just want to be staying with a nasogastric tube. This is particularly important for our audience in the U.S.

Here is why. When patients in ICU end up with a tracheostomy, in the U.S. in particular, and they also end up with a PEG, which is what ICUs often want, the next thing families know is they want to send patients out to LTAC. LTAC stands for long-term acute care facility, or long-term acute care hospital. Those LTACs are not even the better version of a nursing home. Just have a look at the reviews that you can find online for LTACs.

So, by you not giving consent to a PEG tube and by just sticking with a nasogastric tube when you’re giving consent to a tracheostomy, you hold all the cards because most LTACs do not take patients with a nasogastric tube because they can’t manage the nasogastric tube, and that should tell you everything about what you need to know about an LTAC. If they can’t manage a nasogastric tube, that means their skill level is very, very low. How can they possibly look after someone on a ventilator, i.e., life support? So, big problem here.

So, I have made a video about, “Quick tip for families in ICU: Advantages and disadvantages nasogastric tubes versus PEG tube” So, you can look that up, I explained that in much detail.

However, here’s the interesting part. So today, I have been getting a text message from one of our clients who confirms everything that I’ve been saying here for the last 10 years.

Now, this client actually sends me a link to an article, and it says from the American Journal of Medicine from the first of January 2022. So, this is not even two years old. Now, “Clinical research study: Nasal feeding tubes are associated with fewer adverse events than feeding via ostomy in hospitalized patients receiving enteral nutrition.” Now, an ostomy is the synonym for a PEG tube.

I’ll read out this study and I also put the link below this this video where you can access the study yourself.

“Background

Surgical feeding ostomies, or what’s known as gastrostomy or PEG tubes, have become required by many nursing facilities for all patients receiving enteral nutrition, whether for short or long-term use. These policies lack supportive evidence. Comparisons of adverse event rates between surgical and natural orifice tubes are few and lacking in the inpatient setting. Additionally, we hypothesize that adverse events related to feeding tubes are underreported. We sought to quantify adverse events to test the relative safety of surgical feeding ostomies, i.e., PEG tube and the natural orifice, i.e., nasogastric or orogastric feeding tubes in hospitalized patients.

Methods

This was a prospective observational cohort study of enterally fed in patients using semiweekly focused physical examination, scripted survey, and chart reviews.

Results

All tube-fed patients admitted to a large, urban, academic hospital received semiweekly bedside evaluation and chart review over a nine-week period. Total of 1118 observations. Demographics were comparable between 148 subjects with natural orifice and 113 subjects with surgical feeding tubes. A higher incidence of adverse events was observed with surgical tubes, 3.34 versus 1.25 events per 100 subject days. Only 50% of all adverse events were documented in the medical records. More patients with surgical tubes were discharged to skilled nursing facilities.”

Let me repeat that last sentence. More patients with surgical tubes were discharged to skilled nursing facilities or also known as LTAC. This is what I’ve been saying for the last 10 years. You don’t need to believe what I’m saying here. As a matter of fact, you should question everything. But here is another party saying the same thing that I’ve been saying for the last 10 years, and this is a recent study.

Now, let’s continue.

“Conclusions

Surgical feeding tubes are associated with significantly higher in-hospital adverse event rates when compared with natural orifice, nasal or oral feeding tubes. Policies requiring surgical feeding or PEG tubes should be reevaluated.”

Now, this goes on for much longer. Again, I’ll post the link below this video so that you can read the study yourself. I’ll just quickly read at the conclusion.

“In this study, surgical feeding ostomy, also known as PEG tubes, was associated with more frequent and more serious adverse events than natural nasogastric or orogastric feeding tubes, while adverse events event documentation rates were significantly low across both groups. These results suggest that surgical feeding PEG tubes may be a higher risk intervention than natural nasogastric or orogastric feeding tubes in the hospital settings. Clinicians and administrators should consider these results in patient care and discharge and admission policy decisions.”

Yes, they should. So, let me evaluate a little bit more here. So, when we get on calls with ICU team and we say, “Well, here is why this patient shouldn’t have a PEG.” They say, “Well, it’s best practice to do a PEG tube.” It’s nonsense.

You know what is best practice? It’s best practice for a hospital to do a tracheostomy and the PEG and send them out to LTAC because that’s how they can maximize their bed flow and revenue. That is what best practice for a hospital. It’s not patient and family centric. Absolutely not.

What is patient and family centric is to do a tracheostomy when necessary. But even that you should get a second opinion for. What is patient and family centric is to keep the nasogastric tube and get on with recovery, with treatment, and with mobilization. That is what should be happening.

It’s interesting that a hospital says, when we talk to hospitals directly, that it’s common practice and its best practice. Nonsense. It’s absolute nonsense. This article here just confirms what I’ve been saying for the last 10 years.

So, that is my quick tip for today.

Now, we have a membership for families of critically ill patients in intensive care at intensivecarehotline.com when you click on the membership link or when you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email and we answer all questions, intensive care related.

I also offer one-on-one consulting and advocacy for families in intensive care over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I also talk to doctors and nurses directly and I make sure you make informed decisions, have peace of mind control, power, and influence. That’s all part of my 1:1 phone consulting advocacy service.

I have worked in intensive care for over 20 years in three different countries where I have also worked as a nurse unit manager for over five years in intensive care. I have been consulting and advocating for families in intensive care all around the world for the last 10 years with getting great outcomes and great results for families in intensive care. Have a look at our testimonial section.

We also offer medical record reviews in real time so that you can get a second opinion in real time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

Furthermore, I also represent you in family meetings with intensive care teams so that you don’t get walked all over by intensive care teams. Once the intensive care team knows you have someone on your team that knows intensive care inside out just as much as they do, the dynamics will change in your favor.

Now, if you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, comment below what you want to see next and what questions and insights you have, share the video with your friends and families.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.