Jill,

        I did a search on Medline and out of 32 citations, the following 2
were the ones which seemed most appropriate:

Percutaneous feeding tube changes in long-term-care
facility patients.

Graham S, Sim G, Laughren R, Chicoine J, Stephenson E, Leche G, McIntyre M,
Murray D, Aoki FY, Nicolle LE

Deer Lodge Centre, Winnipeg, Manitoba, Canada.

OBJECTIVE: To compare patient outcomes when percutaneous feeding tubes were
changed routinely
each month or only when necessary (prn). DESIGN: Prospective, randomized,
nonblinded crossover
study of 6 months of routine monthly changes compared with 6 months of prn
changes. SETTING:
416-bed long-term-care facility. PATIENTS: 26 permanent residents with
nutrition managed through
percutaneous gastrostomy or jejunostomy feeding tubes. The median age was
61.5 years; 8 (31%)
also had tracheostomies, and 3 (12%) had indwelling urinary catheters.
RESULTS: The frequency of
feeding tube changes was 40 per 1,000 patient-days during the 6 months of
routine tube changes and
14 per 1,000 when tubes were changed prn (P < .001). There were no
differences between the two
study periods in frequency of stoma site infections, fever, episodes of
emesis, and total antibiotic
courses. The median duration in situ of feeding tubes with prn changes was
104 days. For both
periods, feeding tubes were significantly more likely to fall out and
require replacement with-in 24
hours of previous tube replacement. CONCLUSION: There were no observed
differences in clinical
outcomes in long-term-care facility patients when feeding tubes were
changed only as necessary as
compared to routine monthly changes.

Publication Types:

       Clinical trial
       Randomized controlled trial

PMID: 8934240, UI: 97088302



[Percutaneous endoscopic gastrostomy in the
rehabilitation of neurological disorders].

[Article in French]

Glaesener JJ, Fredebohm M

Berufsgenossenschaftliches Unfallkrankenhaus, Querschnittgelahmten-Zentrum,
Hamburg.

Chronic enteric alimentation is preferred to parenteral nutritional support
not only during intensive
care but also during rehabilitation in severe neurologic disorders such as
brain injury and high
tetraplegia. As the long-term placement of nasogastric tubes has several
disadvantages and undesirable
side effects, we chose the nonoperative endoscopic technique for placement
of a transdermal gastric
feeding tube. PEG was performed in 40 patients with neurologic conditions
associated with impaired
swallowing or repeated aspiration problems: 20 patients with CNS trauma, 13
patients with high
tetraplegia and 7 patients with severe neurologic disease of the CNS. The
procedure used was that
described by Gauderer and Ponsky. It was performed under local anesthesia
in the majority of cases
and under intravenous sedation in all cases. Technical problems practically
did not occur, while minor
complications were seen in 15% of the patients treated and major
complications in 2.5%. Because of
the high rate of peristomal wound infections despite systematic antibiotic
prophylaxis, it was assumed
that percutaneous infections could be secondary to contamination of the
transcutaneous wound with
oropharyngeal bacteria and local disinfection of the mouth with betadine
has now been started before
the procedure. Percutaneous endoscopic gastrostomy is a relatively safe
(morbidity of less than 10%),
very practical and cost-effective technique. It is well tolerated by the
patients in whom swallowing
mechanisms are impaired, affords advantages in regard to nursing care and
should therefore belong to
the standard therapeutic procedures in neurologic rehabilitation.

PMID: 1439680, UI: 93068135



>I am looking for information about the incidence of infection in tube fed
>children  (GI tube), especially death rate and cause of death.  Can anyone
>help with statistics or any data at all?
>
>I am researching for a Mom (friend of mine) whose son died in November from
>an infection related to his GI tube.  He was 17 years old, and had Cerebral
>Palsy, and was a very healthy young man. He died quite suddenly, had been
>gagging a bit and was 'not totally himself', but otherwise fine.  He had no
>fever.  He suddenly went into respiratory distress and lost consciousness
>and never came out of it.  He died two weeks later.
>
>Mom is searching for information.... if anyone knows anything about this
>sort of thing, or can send in in the right direction, please let me know.
>
>Thanks,
>
>Jill Jacobs