Feeding After Percutaneous Endoscopic Gastrostomy: Experience of Early Versus Delayed Feeding

Cobell, William J.; Hinds, Alisha; Nayani, Rahul; Syed, Akbar; Lim, Roxanne; Theivanayagam, Shoba; Matteson-Kome, Michelle L.; Choudhary, Abhishek; Puli, Srinivas R.; Bechtold, Matthew L.

doi:10.1097/smj.0000000000000104

Cited by 15 publications

(13 citation statements)

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“…A meta‐analysis of 5 randomized controlled trials compared early feeding after PEG placement (≤3 hours) with delayed or next‐day feeding and found no significant differences in complications, deaths in the first 72 hours, or number of significant gastric residual volumes at day 1 84 . A retrospective study examined the safety and outcomes of early feedings (≤4 hours) during a 5‐year period at a tertiary care center where the majority of PEG procedures were performed on inpatients by gastroenterologists 85 . The mean time of feeding was 3.2 hours for the early group (≤4 hours) vs the delayed (>4 hours) feedings for either overall mortality within 30 days or overall complications such as wound infection, melena, vomiting, leakage, stomatitis, and aspiration pneumonia 85 .…”

Section: Section 4 Enteral Accessmentioning

confidence: 99%

“…A retrospective study examined the safety and outcomes of early feedings (≤4 hours) during a 5‐year period at a tertiary care center where the majority of PEG procedures were performed on inpatients by gastroenterologists 85 . The mean time of feeding was 3.2 hours for the early group (≤4 hours) vs the delayed (>4 hours) feedings for either overall mortality within 30 days or overall complications such as wound infection, melena, vomiting, leakage, stomatitis, and aspiration pneumonia 85 . Kim and associates 86 evaluated the feasibility and safety of implementation of an early tube use protocol compared with the institution's policy on 4‐hour post‐PEG tube placement checks.…”

Section: Section 4 Enteral Accessmentioning

confidence: 99%

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ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

351

531

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Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.

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Section: Section 4 Enteral Accessmentioning

confidence: 99%

Section: Section 4 Enteral Accessmentioning

confidence: 99%

ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

351

531

View full text Add to dashboard Cite

show abstract

“…However, given that patient habitus can vary dramatically, the distance may be adjusted to limit pressure on the abdominal wall. Using this practice over 5 years at one institution, no major complications were identified 45 . Of note, many caregivers like to place gauze between the skin and external bolster.…”

Section: Major Complicationsmentioning

confidence: 99%

“…In addition, a 5‐year retrospective study discovered that complications were no different between feeding within 4 hours and delayed feeding (Figure 2). 45 Based on the literature, feeding within 4 hours of PEG appears safe and should be performed to provide earlier nutrition. An increasing number of institutions are feeding within 3–6 hours after PEG placement 45 – 47 .…”

Section: Feeding After Tube Placementmentioning

confidence: 99%

“… 45 Based on the literature, feeding within 4 hours of PEG appears safe and should be performed to provide earlier nutrition. An increasing number of institutions are feeding within 3–6 hours after PEG placement 45 – 47 . However, there is a lack of literature regarding adequate feeding times after laparoscopically placed gastrostomies and insufficient evidence to suggest early feeding in this group at this time.…”

Section: Feeding After Tube Placementmentioning

confidence: 99%

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Long‐Term Nutrition

et al. 2016

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Long-term nutrition support requires long-term enteral access. To ensure the success of long-term enteral access, many factors need to be taken into consideration. This article represents a guide to placing and maintaining access in patients requiring long-term nutrition and addresses many of the common questions regarding long-term enteral access, such as indications, types of access, feeding after access placed, and recognition and treatment of potential complications. This guide will help the clinician establish and maintain access to maximize nutrition in patients requiring long-term nutrition.

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Immediate‐use strategy is as safe and effective as delayed‐use strategy following percutaneous endoscopic gastrostomy tube placement: A retrospective cohort study

Hanna,

Makar,

Berger

et al. 2023

J Parenter Enteral Nutr

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BackgroundPercutaneous endoscopic gastrostomy (PEG) tube placement is the most common enteral access for long‐term feeding. The aim of our study is to assess the feasibility and safety of immediate PEG tube use after initial placement.MethodsWe conducted a single center retrospective cohort study between August 2006 and August 2016. Prior to August 2011 tube feeding were delayed for 4 or more hours after initial PEG placement, compared with immediate use (< 1 hour) after August 2011. Primary outcomes were complication rates within 30 days of placement. Secondary outcomes were impact of morbidity, mortality, length of stay and need for repeat PEG placement.ResultsOur study included 1296 patients during the 10‐year period, of which 704 underwent delayed use versus 592 underwent immediate use (744 inpatient and 552 outpatient). There were no significant differences between the delayed use and immediate use PEG with regards to complications (3.4% vs 4.4%; p=.76). Subgroup analysis also reflected no significant differences in complications between inpatient and outpatient groups. For inpatients, there were no substantial differences in inpatient mortality (3.9% vs 3.3%; p=.70), mortality within 30 days of discharge (13.8% vs 13.1%; p=.15), readmissions (38.2% vs 34.3%; p=.23), repeat PEG placement (0.7% vs 1.5%; p=.46), and length of stay (13.3 days vs 13.9 days; p=.99).ConclusionPatients who received immediate enteral nutrition after PEG tube placement did not have any increased complications, morbidity, or mortality; and is just as safe when compared to patients who received delayed feeding.This article is protected by copyright. All rights reserved.

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Feeding After Percutaneous Endoscopic Gastrostomy: Experience of Early Versus Delayed Feeding

Abstract: Feeding ≤4 hours after PEG appears to be as safe as delayed feeding. Based on this study and the literature, strong consideration for the majority of patients should be undertaken to begin feeding within 4 hours after PEG.

Cited by 15 publications

References 1 publication

ASPEN Safe Practices for Enteral Nutrition Therapy

ASPEN Safe Practices for Enteral Nutrition Therapy

Long‐Term Nutrition

Immediate‐use strategy is as safe and effective as delayed‐use strategy following percutaneous endoscopic gastrostomy tube placement: A retrospective cohort study

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