What are the common complications associated with NG, NJ, and PEG feeding, and how can they be managed in primary care?

Common complications associated with nasogastric (NG), nasojejunal (NJ), and percutaneous endoscopic gastrostomy (PEG) feeding include:

• Nasogastric feeding: risks include misplacement of the tube leading to pulmonary aspiration, nasal and esophageal irritation, tube blockage, and delayed gastric emptying causing feeding intolerance. Tube position must be confirmed after placement and before each use by aspiration and pH testing, with X-ray if necessary, to prevent misplacement complications.
• Nasojejunal feeding: complications are similar to NG tubes but include additional risks related to tube migration and the need for radiological confirmation of placement. Feeding intolerance due to motility issues may occur, requiring consideration of motility agents.
• Percutaneous endoscopic gastrostomy (PEG) feeding: complications include site infection, tube dislodgement, blockage, leakage around the tube site, and peristomal pain. PEG tubes can be used safely 4 hours after insertion if placed without apparent complications.

Management in primary care involves:

• Ensuring tube position verification protocols are followed, especially for NG and NJ tubes, to prevent feeding into the lungs.
• Monitoring for signs of infection, tube blockage, dislodgement, or leakage, and providing prompt referral to specialist teams if complications arise.
• Supporting patients and carers with training on tube care, feeding administration, troubleshooting common problems, and providing emergency contact details for specialist support.
• Coordinating care with a multidisciplinary team including dietitians, specialist nurses, GPs, and pharmacists to ensure comprehensive management and monitoring.
• Considering the use of motility agents in cases of delayed gastric emptying to improve feeding tolerance.

These measures help reduce complications and ensure safe, effective enteral feeding in the community setting ¹.