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“Nasogastric tube versus PEG (Percutaneous Endoscopic Gastrostomy) feeding tubes in ICU: What families in intensive care need to know.”

My name is Patrik Hutzel from intensivecarehotline.com, where we help families of critically ill patients in intensive care to instantly improve their lives by making informed decisions, get peace of mind, control, power, and influence, even if you’re not a doctor or a nurse in intensive care, even if you’re in a situation that you think you can’t have any power, control, or influence, so that your loved one gets best care and treatment always.

Today, I want to talk about a topic that comes up all the time when your loved one is critically ill in intensive care. It’s the topic of feeding tubes. Many families in intensive care ask, “Should my loved one have a nasogastric tube or a percutaneous endoscopic gastrostomy, also known as a PEG tube?” This is not just a technical question. It’s a question that can have a big impact on your loved one’s recovery, comfort, and long-term outcome. So, let’s break this down.

What is a nasogastric tube?

Nasogastric tube is a thin, sometimes also a big one, flexible tube that goes through the nose and down into the stomach. It’s usually used for short-term feeding, often less than 4 weeks. It can be inserted at the bedside and is easy to remove.

What are advantages of a nasogastric tube?

It’s minimally invasive, it’s non-surgical, quick and easy to insert at the bedside, and ideal for short-term use.

What are disadvantages of a nasogastric tube?

It’s very uncomfortable for patients, high risk of complications such as nasal ulceration, sinusitis, aspiration pneumonia, reflux, tube dislodgement, or blockage. It may not be suitable for long-term feeding in some circumstances.

Now, what’s also important to know here is often when patients are going into ICU, especially when it comes to induced comas, they always end up with a nasogastric tube because that’s sort of what you can do quickly, safely; whereas, the PEG tube requires surgery.

So, as much as you want to give patients and families a choice, when it comes to emergency situations, induced comas in ICU, for example, that need to happen right now, part of that is always to insert a nasogastric tube, because that’s quick and easy.

So then, let’s look at, what is a PEG tube?

A PEG tube is inserted directly into the stomach through the abdominal wall with the help of an endoscope. This requires sedation and is more invasive than a nasogastric tube, but it’s generally used for long-term feeding.

So, let’s look at the advantages of a PEG tube.

• More secure and stable for long-term use. Fewer dislodgements and less frequent replacements.
• Lower risk of aspiration pneumonia compared to nasogastric tubes.
• Better long-term nutritional outcomes, particularly beneficial in stroke, brain injury, head and neck cancer patients, but also for anyone that’s got a high spinal injury, long-term ventilation needs with tracheostomy, where a patient cannot be weaned off the ventilator, whether that is from a high spinal injury, whether that is from cerebral palsy, spinal muscular atrophy, and so forth.

Let’s look at disadvantages of a PEG tube.

• Invasive procedure that carries risks such as infection, bleeding, or peritonitis.
• Higher upfront costs.
• Not suitable in patients with advanced dementia or end-stage illnesses, where it doesn’t improve survival or quality of life.

But it can absolutely improve the quality of life for some patients and their families, especially when it comes to end of life situations where it can actually prolong life. So, it’s really up to patients and families —a decision.

Now, let’s look at some of the evidence. Research can be clear or can be ambiguous whichever way you want to look at this. So, nasogastric tube is ideally kept for short-term use, however, it can also be used for long-term use. When your loved one is expected to recover swallowing function within weeks or when invasive procedures carry too much risk. But there’s also a difference in countries, and I’ll come to that. Different countries have different approaches.

Let’s look at the PEG tubes. PEG is more effective and safer for patients who need long-term feeding support, such as for someone that’s potentially ventilated and tracheostomized for the rest of their lives, or who’s tracheostomized for the rest of their lives and can’t swallow even without a ventilator.

Some studies show that patients with PEG have better nutritional markers and lower pneumonia-related mortality compared to those with a nasogastric tube.

However, let’s look at some more nuances. In countries like Australia or the U.K., a PEG tube is often done much slower than in the U.S. So, in the U.S., for example, there is an emphasis on getting a PEG tube done as quickly as possible whenever a patient is having a tracheostomy.

From my experience in having worked in critical care nursing for over 25 years in three different countries, where I also worked as a nurse manager in intensive care for over 5 years, is premature to do a PEG just with a tracheostomy, and then to send them to an LTAC (Long Term Acute Care), that’s in the U.S. only. A nasogastric tube, from my extensive experience can stay in for up to 6 months.

Here is another disadvantage of a PEG tube, I should say. When patients get a PEG tube, the way a PEG tube is perceived in the medical community and in the nursing community is that this patient will never ever eat again, ever again. Now, that perception comes with implications such as, “Oh, we won’t even bother trying to get this patient to eat and drink and swallow again.” That’s not a good starting point. Whereas if someone has a nasogastric tube, there’s always the perception it’s temporary. We got to get this patient back to eating and drinking. It’s as simple as that. It’s a perception issue as well.

So, when to use the nasogastric tube feeding?

• Short-term need (less than 4 weeks)
• Patient’s condition is expected to improve
• Quick, non-invasive feeding access is required
• When surgery or sedation is too risky

But also, for our audience in the U.S., it should also be used to avoid an LTAC. Because when your loved one in the United States in ICU, has a tracheostomy and the PEG tube, they can go to an LTAC (Long-Term Acute Care), and we strictly recommend patients not going to LTAC. It’s a disaster zone. Whereas, if a patient has a tracheostomy and a nasogastric tube, which is perfectly fine, the chances of your loved one going to an LTAC are much lower.

I’ve made a video with the title, “10 Reasons Why LTACs in the U.S. are a Scam,” and I will link to it in this blog post.

So, when to avoid a PEG tube?

• Advanced dementia or end-stage illnesses— if there’s no perceived benefit, and if it’s a patient wish, and if there’s potential harm.

But if the patient or the family wishes to have a PEG tube to prolong life, then all power to you when you should be advocating for that, and we can help you with that advocacy.

• Contraindications such as severe coagulopathy, peritonitis, massive ascites, or GI obstruction.

Final thoughts. The decision between a nasogastric tube and PEG is not just medical, it’s about quality of life, comfort, and the best possible outcomes for your loved one. I can tell you, just keeping it with our audience in the U.S., going to LTAC will not be the best outcome for your loved one, I can guarantee you that. So, stay clear of a PEG tube prematurely if you’re in the United States.

If your loved one is in ICU and the medical team is pushing you to make a decision about a feeding tube, you don’t have to make that decision alone. At intensivecarehotline.com, we specialize in helping families in situations just like this fast to make informed choices and informed decisions.

So, reach out to us at intensivecarehotline.com. Call us on one of the numbers on the top of our website, or simply send us an email to [email protected].

Also, as a bonus point, for example, with Intensive Care at Home, and you can find more information at intensivecareathome.com. We do both at home. We do nasogastric tubes, we do PEG tubes, doesn’t make a difference to us. It is really up to the client how they want to be looked after. Go and check out intensivecareathome.com. Take care for now.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy, because of our insights. You can verify that on our testimonial at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews. Because our advice is absolutely life-changing.

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care.

That’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always. That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

That’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. I also represent you in family meetings with intensive care teams.

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

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if 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. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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Thank you so much for watching.

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

Take care for now.