The Development of Validated Standards of Nutrition Care for Patients Post-Percutaneous Endoscopic Gastrostomy Placement

Abstract Forty-eight patients referred for percutaneous endoscopic gastrostomy (PEG) tube placement from April 1, 1994 to March 15, 1995 underwent successful PEG placement. Nutrition classification, nutritional status, weight, electrolytes, albumin and total lymphocyte counts were assessed pre-procedure. Twenty-six patients were randomized to a fast feeding protocol with advancement of feedings every 8 hours to full feedings (100ml/hr of isotonic formula) over 24 hours. Twenty-two patients were randomized to a slow feeding protocol with advancement of feedings every 24 hours to full feedings over 72 hours. Both protocols used pre-printed orders that were developed by an interdisciplinary team of dietitians, physicians and nurses. The patients were evaluated daily by the PEG assessment team and residuals were monitored. Reasons for obtaining a PEG were poor oral intake (66%), risk of aspiration (27%) and dysphagia (8%). The twenty-four swallowing studies performed were all abnormal. Only 29 of the patients had been on tube feedings prior to PEG placement with 50% on chronic tube feedings. Nutrition classification in our patients were marasmus (21%), hypoalbuminemia (25%) and combination state malnutrition (19%). Nutritional status in our patients were mild compromise (4%), moderate compromise (65%) and severe compromise (31%). Twenty-five percent of patients were less than 80% ideal body weight, 42% had an albumin less than 2.7gm/dl and 52% had an abnormal lymphocyte count as defined to be less than or equal to 1200. All but one patient were able to be advanced to full feedings. Nursing compliance with the orders was 92%. There was no significant difference in residuals, compliance or the very few complications between the fast and slow feeding groups. Thirty patients were tried on bolus feedings with 90% success and the average time to bolus feedings was three days. We have shown that an interdisciplinary approach can produce a protocol which are clear, comprehensive and allow rapid advancement of feeding in the post-PEG period.