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Exclusive Cochrane summary

Guidance for feeding adults with swallowing disturbances

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This Cochrane review compared the safety and efficacy of percutaneous endoscopic gastrostomy with nasogastric tube feeding for adults who have swallowing disturbances

Carlson G (2011) Nursing Times; 107: 41, early online publication.

  • Figures and tables can be seen in the attached print-friendly PDF file of the complete article

Review question

Is a percutaneous endoscopic gastric tube (PEGT), as opposed to a nasogastric tube (NGT), the safest and most efficacious one to use in patients who have swallowing disturbances?

Nursing implications

Nurses are responsible for ensuring adequate nutrition by maintaining enteral tube patency and reducing interruptions in feeding, so thereby minimising complications. However, the evidence is inconsistent about the use of percutaneous endoscopy gastrostomy (PEG) feeding in people with swallowing difficulties. This review aimed to compare the effectiveness and safety of PEGTs with NGTs.

Study characteristics

This summary is based on a Cochrane review containing nine randomised controlled trials with a total of 686 participants with an age range of 20–96 years. Study participants had to be adults presenting with swallowing disturbances or dysphagia who required nutritional support. People with any underlying diseases were also accepted.

Interventions (a PEGT performed by any method) were compared with controls (an NGT, irrespective of technique).  Studies containing radiologically inserted gastrostomy, nasojejunal tubes and jejunal tube PEG were excluded from the review.

The primary outcome was intervention failures such as the inability to place the tube, recurrent displacements and treatment interruptions, leakage or blockage, or no adherence to treatment. Secondary outcomes included mortality, complications (haemorrhage, pneumonia, wound infections, sinusitis and fistula), time on enteral nutrition, quality of life (measured by any validated instrument), length of hospital stay, nutritional status and cost. 

Most of the studies conducted follow-up at three to six months. The authors noted that nearly half of the studies did not report the method used to sequence and conceal allocation. Meta-analysis was undertaken where possible.

Summary of key evidence

Intervention failure occurred in 12.17% of the PEGT groups and 39.87% of participants receiving an NGT. This indicated a significant difference in favour of using a PEGT rather than an NGT. There was no significant difference in mortality, complications, pneumonia and functional ability between groups.

Best practice recommendations

Evidence from a systematic review suggests that using a PEGT, rather than an NGT may be beneficial in maintaining continuous nutrition, with less interruption related to leaking, clogging, inability to place the tube, or adherence to treatment regimen. Although the incidence of complications, mortality, pneumonia and functional ability were not statistically significant, the use of a PEGT instead of an NGT may save nursing time and provide patients with nutrition that is closer to their caloric needs. 

The full review report, including references, can be accessed at www.tinyurl.com/pegt-ngt-coch-review

Glenn Carlson is clinical nurse specialist and acute care nurse practitioner for Adult critical care at Bronson Methodist Hospital and a member of the Cochrane Nursing Care Field

 

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