Peg Hole

Peg Hole

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↑ Stroke Engine. Nine Hole Peg Test. Available from: http://strokengine.ca/en/assessments/nine-hole-peg-test-nhpt/ (Accessed 11/08/2022)

↑ Jump up to: 2.0 2.1 Shirley Ryan Ability Lab. Nine Hole Peg Test. Available from: https://www.sralab.org/rehabilitation-measures/nine-hole-peg-test (Accessed 11/08/2022)

↑ Jump up to: 3.0 3.1 Mathiowetz, V., Kashman, N., et al. "Grip and pinch strength: normative data for adults." Arch Phys Med Rehabil 1985 66(2): 69-74

↑ Sommerfeld, D. K., Eek, E. U., et al. "Spasticity after stroke: its occurrence and association with motor impairments and activity limitations." Stroke 2004 35(1): 134-139

↑ Jump up to: 5.0 5.1 Heller, A., Wade, D. T., et al. "Arm function after stroke: measurement and recovery over the first three months." Journal of Neurology, Neurosurgery and Psychiatry 1987 50(6): 714-719

↑ Jump up to: 6.0 6.1 Grice, K. O., Vogel, K. A., et al. "Adult norms for a commercially available Nine Hole Peg Test for finger dexterity." The American journal of occupational therapy 2003 57(5): 570-573

↑ Chen, H. M., Chen, C. C., et al. "Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke." Neurorehabil Neural Repair 2009 23(5): 435-440

↑ Earhart, G. M., Cavanaugh, J. T., et al. "The 9-hole PEG test of upper extremity function: average values, test-retest reliability, and factors contributing to performance in people with Parkinson disease." J Neurol Phys Ther 2011 35(4): 157-163

↑ Jump up to: 9.0 9.1 Wang, Y. C., Magasi, S. R., et al. "Assessing dexterity function: a comparison of two alternatives for the NIH Toolbox." Journal of Hand Therapy 2011 24(4): 313-320; quiz 321

↑ Mendoza-Sánchez S, Molina-Rueda F, Florencio LL, Carratalá-Tejada M, Cuesta-Gómez A. Reliability and agreement of the Nine Hole Peg Test in patients with unilateral spastic cerebral palsy . Eur J Pediatr. 2022 Jun;181(6):2283-2290.

↑ Sunderland, A., Tinson, D., et al. "Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator." British Medical Journal 1989 52(11): 1267

↑ Cutellè C, Rastelli E, Gibellini M, Greco G, Frezza E, Botta A, Terracciano C, Massa R. Validation of the Nine Hole Peg Test as a measure of dexterity in myotonic dystrophy type 1. Neuromuscul Disord. 2018 Nov;28(11):947-951.

↑ Parker, V. M., Wade, D. T., et al. "Loss of arm function after stroke: measurement, frequency, and recovery." Int Rehabil Med 1986 8(2): 69-73

↑ Smith YA, Hong E, Presson C. Normative and validation studies of the Nine-hole Peg Test with children. Percept Mot Skills. 2000 Jun;90(3 Pt 1):823-43

↑ Beebe, J. A. and Lang, C. E. "Relationships and responsiveness of six upper extremity function tests during the first six months of recovery after stroke." J Neurol Phys Ther 2009 33(2): 96-103

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The Nine-Hole Peg Test (9HPT) is used to measure finger dexterity in patients with various neurological diagnoses [1] .

Patients with Stroke , Brain Injury , Parkinson's , Multiple Sclerosis or other neurological conditions [2] .

Stroke: (Chen et al, 2009, Acute and Chronic Stroke) [7]

(Wang et al 2011; n = 305; mean age = 32 (26); age range = 3 - 85 years) [9]

(Heller et al, 1987; n = 56; mean age = 72 (9.9) years; assessed < 3 months post-stroke, Acute Stroke) [5]

Stroke: (Sunderland et al, 1989; n = 38; mean age = 67, Acute Stroke) [11]

Healthy Adults: (Wang et al, 2011) [9]

Stroke: (Parker et al, 1986; 2 weeks, 3 & 6 months post onset, Acute Stroke) [13]

(Smith, Hong and Presson, 2000) [14]

(Beebe and Lang, 2009, Acute Stroke) [15]

Responsiveness was calculated using the single population effect size method. Values closer to 1.00 = more responsive to change. Low responsiveness < 0.20; moderate responsiveness < 0.50, and high responsiveness < 0.80

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PEG tube stands for the abbreviation Percutaneous Endoscopic Gastrostomy (PEG) tube [Percutaneous (through the skin) – Endoscopic (using an endoscopic instrument) – Gastrostomy (means to the stomach)] is also called gastrostomy tube, which is a feeding tube that is a safe and effective way to provide food, liquids and medications (when appropriate) directly into the stomach. An endoscope is a long thin flexible tube with a small camera and light attached which allows the doctor to see the pictures of the inside of your gut on the video screen. The endoscope allows the doctor to choose the best location in the stomach to place the PEG tube. The PEG tube procedure is done for patients who are having trouble swallowing. PEG tube placement can generally be performed under local anesthesia rather than general anesthesia. The surgeon will give you an injection of local anaesthetic into the skin. An endoscope is passed into the mouth, down the esophagus, and into the stomach. Your stomach connects the esophagus to the small intestine, and acts as an important reservoir for food, prior to delivery to the small intestine (see Figure 1). Once the location is chosen and under direct visualization with the endoscope, a small opening is made on the outside of abdomen into the stomach. After the opening is made, the top part of the PEG tube is pulled up out of the stomach through the skin of the abdomen (abdominal wall). The top of the PEG tube rests on the skin and the bottom part of the PEG, which is shaped like bulb, remains inside the stomach. This bulb shape anchors the tube in the stomach and prevents it from coming out.
PEG gastrostomy tubes avoid the need for general anesthesia and a large incision. This procedure may or may not require a sedation anaesthetic.
However, if the PEG tube can’t be placed into your stomach, you may have a percutaneous endoscopic jejunostomy (PEJ) tube placed instead. A percutaneous endoscopic jejunostomy (PEJ) tube is placed in your jejunum, which is the second part of your small intestine.
PEG tube is prevented from coming out of the stomach by one of several methods. Some brands have a small wire within the tube, which after insertion is pulled from the exterior end of the tubing causing the portion within the stomach to curl up or “pigtail,” preventing it from being pulled out. Other systems employ a very small balloon at the end of the tube which is inflated within the stomach after insertion, serving the same purpose. Removal of the PEG tube simple involves cutting the wire which created the pigtail, or deflating the balloon section of the tube allowing it to slip easily from the stomach. About three inches of tubing will protrude from the incision area. Initially, there may be some discomfort while getting used to using the system, from gas or air, or from adjusting to the liquid foods themselves.
Your physician may recommend that you have PEG tube feeding tube procedure if you require long term nutritional support because you are unable to eat food normally, in order to make sure you are getting adequate nutrition.
PEG tube procedure can also be performed to shrink the stomach in cases of a bowel obstruction.
PEG tubes are inserted for other various reasons. They may be needed temporarily or permanently.
The PEG tube which is made of silicone, must stay in the stomach for about three months to allow the tract (hole) to heal between the abdomen and the stomach. The tract must be well healed so it is safe for the gastrostomy tube to be changed.
PEG tube might be recommended if you have difficulty eating, but your digestive system works normally. Examples include:
First introduced in 1980, today more than 200,000 patients every year receive PEG tube therapy.
What are possible complications of PEG tube
Your stomach and abdomen generally heals in 5 to 7 days. Moderate pain can be managed with medications. You will be fed intravenously (IV) for at least 24 hours. Feedings will begin when your bowel sounds are heard. Feedings will start slowly with clear liquids and gradually be increased.
You and your family will be taught:
Clear fluids, often water, will be given initially through the PEG tube 6-24 hours after its insertion. Once this is tolerated, then feeds and medications may be given through the tube. Medications can also be given through the PEG tube but care is needed as some medications can clog up the tubing. Your pharmacist will advise you with this.
Complications can occur with the PEG placement. Possible complications include pain at the PEG site, leakage of stomach contents around the tube site, and dislodgment or malfunction of the tube. Possible complications include infection of the PEG site, aspiration (inhalation of gastric contents into the lungs), bleeding and perforation (an unwanted hole in the bowel wall). Your doctor can describe for you symptoms that could indicate a possible complication.
When the PEG tube is used for feeding there are 2 major common risks:
Chronic leakage around the site is NOT normal. If the PEG stoma is oozing blood, food, stomach acids, or any other substance, then you need to see your GI or visit the emergency room immediately.
This depends on the type of tube you have inserted, and how it is looked after.
A PEG tube can last up to a year but will need to be changed every so often due to the stomach acids. The PEG tubes can become blocked by food, residue or medications. It should be flushed well after each use.
If the PEG tube falls out, it is important to have another tube placed as soon as possible to prevent the hole closing over.
The PEG tube can be replaced by another tube or by a low profile device, also called a ‘button’. You should discuss this option with your doctor when your PEG tube is due to be changed.
If the PEG tube is no longer needed it can be simply removed and the exit hole will quickly close over. Sometimes it may require a small operation by a surgeon to repair the hole once the tube is removed.
Specialized liquid nutrition, as well as fluids, are given through the PEG tube. If the PEG tube is placed because of swallowing difficulty (e.g., after a stroke), there will still be restrictions on oral intake. Although a few PEG patients may continue to eat or drink after the procedure, this is a very important issue to discuss with your physician.
Nutritional support is an important component of care for the critically ill. It is possible to be given nutrients and fluids through a naso-gastric tube.
The feeding tube can be placed directly into your stomach by an operation.
It is also possible to be given nutrients and fluids directly into your bloodstream (parenteral nutrition).
For patients with a functioning gastrointestinal (GI) tract, enteral nutrition is preferred to parenteral nutrition (into your bloodstream). Enteral nutrition is safer, more physiologic, and economical 1) . In the intensive care unit (ICU) setting, enteral nutrition is associated with a decreased likelihood of developing infections when compared to parenteral nutrition. In patients with acute pancreatitis, use of enteral nutrition is also associated with a reduction in hospital length of stay and a trend toward reduced organ failure when compared to parenteral nutrition. Patients who have a functioning gastrointestinal (GI) tract but are unable to safely ingest oral intake are fed via enteral access. In patients in whom long-term enteral access is required, endoscopically placed enteral access is recommended. Percutaneous endoscopically placed gastrostomy (PEG) and jejunostomy (PEJ) tubes are utilized for long-term enteral nutrition.
It rarely happens with a PEG tube and sometimes happens with the Malecot® or balloon gastrostomy tubes. If the tube becomes accidentally dislodged call your doctor for instructions.
If you do not speak to a doctor or nurse after thirty (30) minutes, go to nearest emergency room in a hospital for tube reinsertion (make sure you bring your gastrostomy supplies with you). A tube will be placed into the gastrostomy tract to prevent closure and the need for another operation. If the emergency room doctors and nurses have questions, they can call your gastroenterologist, or surgeon who placed the tube.
If you do not have a replacement gastrostomy tube to take with you, a FOLEY® catheter of the same size or smaller can be inserted as a replacement tube. Often, a special x-ray called a “gastrostomy tube dye study” will need to be taken to make sure the newly placed tube is in the stomach. A FOLEY® catheter can be used for feeding and stomach decompression at home. Call your GI or surgical doctor or nurse if you required a visit to the emergency room for care of your gastrostomy tube.
During the PEG tube placement procedure, a physician places an endoscope (a long, thin, flexible instrument about 1/2 inch in diameter) into your mouth. The endoscope is then advanced through your esophagus (the “food pipe” leading from your mouth into your stomach) and into your stomach. The endoscope is used to ensure the correct positioning of the PEG tube (also called a feeding tube) in your stomach. The PEG tube rests in the stomach and comes out through the skin of the abdomen.
The percutaneous endoscopic gastrostomy (PEG) tube provides nutrition for patients who are having trouble swallowing. The internal bumper rests in the stomach, and the adapter comes out through the skin of the abdomen.
You will meet with a physician, dietitian and home care coordinator. They will review your history, discuss the procedure and answer any questions you might have.
Tell the physician if you have a lung or heart condition, a bleeding tendency or if you are allergic to any medications.
Do not eat or drink anything for 8 hours before the procedure.
You will need to bring a responsible adult to accompany you after the procedure. You should not drive or operate machinery for 24 hours. The medication given during the procedure may cause drowsiness, making it unsafe for you to drive or operate machinery.
You may be asked to stay overnight at a location that is within 30 minutes from where your procedure was performed.
On the day of the PEG tube placement procedure
You may need to stay overnight in the hospital after the procedure, so please pack any personal items that you may need.
You will meet with a physician who will explain the procedure in detail, including possible complications and side effects. The physician will also answer any questions you may have.
You will be taken to the Post Anesthesia Care Unit (PACU), where your nurse will monitor your temperature, heart rate, breathing, and blood pressure. They will also check the bandage around your tube. You will stay in the PACU until you’re fully awake.
Cleanse the area around the PEG tube with water for the first two days after placement. After this, daily bathing with soap and water is all that is necessary. Daily showers should be sufficient to keep the stoma site clean after it has healed from the initial surgery. To clean the skin around the PEG tube, lift up the flap, inspect the area; wash the skin with soap and water and dry the skin completely. Most PEG tubes do not need a dressing. A small amount of drainage is normal. Turn the tube with each feeding to prevent skin irritation.
Every day, inspect the skin around your feeding tube for any redness, swelling, or pus. Tell your doctor or nurse if you’re having any of these symptoms.
The PEG tube is marked at the point where it should be level with the incision and should be checked regularly to make sure it is still properly in place. Excessive tension on the tube may result in pressure necrosis (death of an area of tissue) of the interior abdominal wall. Excessive tension may also cause the tube to be pulled out prematurely.
If the tube becomes too loose, spacers, may be placed between the PEG and the skin to provide a better fit. If the tube gets too tight and there are spacers in place, these can be removed anytime, by your GI nurse or doctor.
Should the PEG tube accidentally come out, the original tube–or a replacement–needs to be placed back in the stoma as soon as possible or the incision will begin to heal, and new surgery may be required. Stomas could begin to close up in less than two hours. It is important you to have a spare, balloon tube (or a Foley Catheter, which also has a balloon) at home in case your tube comes out and you don’t have immediate access to an emergency room.
After three months you may choose to replace the PEG tube with the same type of tube or you may change to a balloon type gastrostomy tube. Talk with your nurse or doctor about the best tube for you. If the PEG tube is working well and does not need to be changed at 3 months, it may stay in for up to one year.
You should regularly rotate your PEG tube, beginning a few days after initial placement. This makes sure the tissue and skin around the area haven’t stuck to the tube and will give you a good healthy stoma. It’s recommended that you rotate the PEG tube at least a quarter turn once a day. The best time is probably right after you bathe. If the tube feels tight and is difficult to turn, be sure not to force it. Make sure there is a little space in and out for the tube. If it’s too tight against the skin, slide the PEG-tube bumper up slightly. If your tube is held in place by a balloon, check to see if there is enough water in the balloon. It could be that the balloon has burst or eroded–this necessitates a tube change. If the feeding tube freely moves in and out and the balloon appears undamaged, try lubricating the stoma with a little water-based lubricant. If you don’t have lube, you could try using vegetable oil. Vaseline, or other petroleum-type lubricants, erode the plastic in the feeding tube over time so you should avoid using these. Once the PEG tube is lubricated, try rotating it again. Use as much gentle force as you’re comfortable with but note any pain or discomfort. Don’t panic if your tube won’t rotate. Stomas commonly get tight due to bloating, recent tube placement, or tube chan
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