Posted on November 6, 2017

Many nursing home residents have a feeding tube due to their inability to properly feed themselves or take in nutrition as a healthy individual would normally do. This includes nursing home residents with swallowing problems, appetite disorders, or a variety of issues that can occur in the elderly compromising their ability to take anything by mouth.

PEG Tubes Allow Nutrition and Fluids to Be Delivered Regardless of Physical Limitations

Typically, a resident in this situation has what is referred to as a PEG tube. PEG stands for percutaneous endoscopic gastronomy. A patient requiring a PEG undergoes a procedure in which a flexible feeding tube is placed through the patient’s abdominal wall and into their stomach. This enables the patient to have nutrition placed directly into their stomach for digestion. This allows the patient's mouth and esophagus to be bypassed thereby allowing physically compromised individuals to maintain adequate nutrition despite their limitations. A PEG also allows the nursing home staff to deliver fluids and medications directly into the stomach to compensate for individuals unable to take anything by mouth. Nursing home residents receiving nutrition through their PEG are given specialized liquid nutrition products. Ensure is often given to nursing home residents in addition to other TPN products.

Implanting a PEG Tube Requires Surgery

A surgeon will perform the procedure for implanting a PEG. This is normally done under general anesthesia. The doctor creates a small opening in the upper abdomen and directly into the stomach. The flexible tubing is then guided through the opening to create a direct line into the stomach. An inflatable balloon device is often used to secure the tube once placed. Proper placement is usually verified via direct visualization during the procedure using ultrasonography or post-procedure via imaging studies.

Proper Post-Surgical Care Is Essential

Once placed, the patient should be given antibiotics and have their PEG monitored very closely for signs of leakage and infection. A dressing is usually applied for a few days. Subsequent to removal of the dressing, the site should be cleaned at least once a day. Most patients leave surgery and return to the nursing home the same or next day.

PEG Tubes Can Lead to Complications Not All Kentucky Senior Care Facilities Are Equipped to Handle

Although most nursing homes and long-term rehabilitation centers in Kentucky accept residents that have a PEG, it is important that their staff is properly trained to care for a nursing home resident that has a PEG. Without proper training of the nursing home staff, a resident is at risk for injury and even death as a result of an improperly cared for PEG. Warning signs and symptoms of problems with a residents PEG include:

  • Pain
  • Leaking around the PEG tube site
  • Dislodged tubing
  • Twisted or kinked tubing
  • Clogged tubing

Left untreated, problems with the PEG can result in infection of the tissue around the tube site, aspiration of stomach contents into the patient’s lungs, and bleeding or trauma to the tissue surrounding the tube and the insertion sites. Any of these serious conditions must be addressed immediately to prevent permanent harm and death.

Our Nursing Home Neglect Attorneys Have Handled PEG Tube Cases Before

Our firm has represented many families across Kentucky and throughout the country in their claims against nursing homes, rehab facilities, and senior living centers for improper feeding tube care. We recently concluded a case involving a nursing home resident in Kentucky that had a PEG tube placed prior to their admission to the nursing home. Although the nursing home staff and administrator assured the family that their mother would be properly cared for and that they were equipped to handle residents with PEGs, this turned out not to be true.

Although caring for the PEG was listed as necessary on their mother’s Care Plan, she was not getting the care she required. Over a period of several days, the resident developed an infection that leads to peritonitis and sepsis. Ultimately, she passed away from the uncontrolled sepsis. The patient’s medical records in the nursing home revealed that the resident was not receiving routine and necessary checks of her PEG. Several days were absent of any documentation indicating the nursing staff checked on the PEG. When the medical records started mentioning the PEG again it was noticed that the resident had redness surrounding the tube site. Unfortunately, this was not investigated and no action or physician orders were noted concerning addressing the redness which is often a sign of infection.

Incredibly, several more days again passed until any mention was made covering the PEG. When it was again mentioned, it was noted that the resident had redness around the site, swelling around the PEG and that that tubing was loose. A vitals check noted increased heart rate. Labs were finally taken and showed an elevated white blood count. Films were ordered which showed that the tube had become dislodged from the resident’s stomach and nutrition supplement had leaked into the abdominal cavity. As a result of the dislodged tube, the resident had developed an inflammatory infectious process in their abdomen resulting in peritonitis, a very serious abdominal infection requiring immediate surgical intervention. The patient became increasingly ill, developing sepsis and passed away the next day. It is believed that the tube may have been dislodged for as much as 9 days slowing leaking nutritional supplements into her abdomen. Had proper monitoring of her PEG occurred, this tragedy could easily have been avoided. This case settled before trial for a confidential amount.

Aspiration and Peritonitis Are Common Results of Neglecting Proper PEG Tube Care

Our law firm has been involved in many cases where the nursing home resident aspirates due to negligent care of their feeding tube. Aspiration in nursing home residents often results in pneumonitis or pneumonia which often leads to death. Risk of aspiration in a patient with a feeding tube can increase due to the level of sedation of the resident, the frequency of the suctioning of the tube, and the degree of the elevation of the head of the bed. Bottom line, vigilant care by the nursing home staff is the best prevention of aspiration in residents with PEG’s. In almost all cases of nursing home abuse and neglect, the nursing home staff failed to do their job. Unfortunately, the staff at many nursing homes is often doomed to fail because they are terribly understaffed and unable to care for the number of residents they have in their home.

Nursing home owners often provide inadequate training to their staff and expect them to handle residents that they are not equipped to handle. This is often the result of the owners of the nursing homes using as little staff as they can get away with in order to increase their profits. When a healthcare company puts profits over people, injuries are sure to occur.

Peritonitis is another condition that our firm is all too familiar with when representing residents with PEG tubes injured by nursing home negligent. Peritonitis, once developed, carries a very high mortality rate. Nursing home staff must be extremely mindful to closely watching residents with PEG tubes for signs and symptoms of peritonitis such as:

  • Abdominal pain
  • Fever
  • Increased white blood cell count (leukocytosis)
  • Swollen abdomen

Peritonitis can develop in residents with PEGs when the tube becomes dislodged or displaced or there is leakage or perforation of internal organs or tissue as a result of the PEG. If any of these conditions is suspected, a radiographic study with contrast through the PEG can help determine if such a condition is occurring. CT scans can also be used to ascertain damage to internal organs and tissue. Broad-spectrum antibiotics should be given to prevent or control infection. If a perforation is determined, then surgery is most often required. Therefore, nursing home residents with PEG’s must be monitored and cared for using extreme caution because the corrective surgery is often not an option due to their already frail condition.

Has Your Loved One Been Injured In A Nursing Home?

If you believe your loved one is being subjected to nursing home abuse you need to speak with an experienced Kentucky nursing home neglect attorney as soon as possible. Contact us online or call our office directly at 888.450.4456 to schedule a free consultation.

Matthew L. White
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Founder & Partner of Louisville Personal Injury Law Firm Gray & White Law