Sa1644 Evaluation of Forces Required for Inadvertent Removal of Percutaneous Endoscopic Gastrostomy (PEG) Devices

Abstract

Sa1644 Evaluation of Forces Required for Inadvertent Removal of Percutaneous Endoscopic Gastrostomy (PEG) Devices John C. Fang, Kristen Hilden Gastroenterology, University of Utah, Salt Lake City, UT Introduction: Solid mushroom type bolster or water filled balloons are the most common internal retention devices for PEG’s. It is these internal retention devices that resist accidental or inadvertant removal of PEG’s from external traction. For a balloon type replacement PEG’s the removal force may differ by differ by size (volume) of retention balloon or whether balloon bursts upon removal. The difference in forces required to remove PEG’s with these different retention devices have not been previously reported. Methods: Four solid internal bolster initial placement PEG’s were placed into 2 live pigs. Eleven days later the initial PEG’s were removed and replacement balloon PEG’s were placed and removed immediately. Force of external traction removal was measured using strain gauge meter and measured in psi. The 4 initial placement solid internal bolster PEG’s (14-24F Endovive Standard PEG) and 26 balloon type replacement PEG’s (14-24F Endovive Standard Profile Balloon Replacement Feeding Tubes (n 20), Kimberly Clark MIC Gastrostomy Feeding Tubes (n 6)) were tested. Balloons were inflated with sterile H2O to various volumes (5-20 cc) per manufacturers directions. For balloon type PEG’s the balloons were left inflated when removal forces were tested. Results: The force to remove retention balloons (n 26) was significantly greater than the force required to remove the solid internal bolster PEG’s(n 4)(14.4 0.6 vs.7.4 0.9 respectively;p 0.0004). The force to remove undeflated balloon PEG’s did not differ by volume of the balloon (p NS for comparisons of different sized balloons). The force to remove undeflated balloon type PEG’s did not differ by whether the balloon burst upon removal or not (16.1 3.0 vs. 14.4 2.7 respectively)(see tables). Conclusions: Balloon type PEG’s required significantly more force to remove than solid internal bolster PEG’s. The force for removing balloon type replacement PEG’s did not differ by volume that the balloon was inflated to or whether retention balloons burst (vs. not bursting) during traction removal. This data has important implications for choosing and designing PEG’s in patients at risk for inadvertent removal.