Department of Nursing, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan.
JMIR Mhealth Uhealth. 2023 Oct 20;11:e48970. doi: 10.2196/48970.
Percutaneous endoscopic gastrostomy (PEG) is commonly chosen for long-term enteral nutrition support. However, common complications of PEG include wound infection, leakage, obstruction, bleeding, dislodgement, pneumonia, peritonitis, and more. The anticipation of these complications by both patients and their family caregivers underscores the essential requirement of ongoing technical guidance for the daily care of PEG and the adoption of preventative strategies.
This study aimed to establish and compare a health education program utilizing a tracking system for PEG using a mobile app (PEG app) and instant messaging software versus a paper-based health education program with instant messaging software. Their effectiveness in preventing complications, avoiding hospital readmissions, improving self-care practices, and enhancing quality of life outcomes was assessed.
A randomized controlled trial design was used, and the study sample consisted of patients from a medical center in central Taiwan who underwent thoracic surgery or gastroenterology procedures. Inclusion criteria were being a new case undergoing his or her first gastric tube insertion and having the ability to operate a smartphone. Exclusion criteria were cases requiring tube replacement or nasogastric tubes. A total of 74 participants were enrolled, with 37 participants in the experimental group and 37 participants in the control group. Data collection took place from hospitalization until 1 month after discharge. The experimental group received care using the gastric tube tracking system (PEG app) and the Line app that included phone, text, and photo capture capabilities, while the control group received routine nursing care and used the Line app.
The experimental group demonstrated a significant reduction in the occurrence of complications compared with the control group (χ=12.087, P=.001). Specifically, the occurrence of leakage events was significantly lower in the experimental group than in the control group (χ=12.906, P=.001). However, the experimental group exhibited superior self-care ability compared with the control group (t=2.203, P=.03). There was no significant difference in overall quality of life scores between the experimental and control groups (t=1.603, P=.11). However, the experimental group showed better social aspects of quality of life than the control group (t=2.164, P=.03).
Integration of the PEG app with instant messaging can enhance self-care ability, improve social aspects of quality of life, and reduce complications. The study results suggest that the PEG app could be used as an adjunct tool to promote patients' self-directed management of their gastric tube at home, particularly for patients who have undergone their first PEG placement and are being discharged from the hospital.
Chinese Clinical Trial Registry ChiCTR2300071271; https://tinyurl.com/4vvy584e.
经皮内镜下胃造口术（PEG）常用于长期肠内营养支持。然而，PEG 的常见并发症包括伤口感染、渗漏、梗阻、出血、移位、肺炎、腹膜炎等。患者及其家属对这些并发症的预期强调了对 PEG 日常护理进行持续技术指导以及采取预防策略的必要性。
本研究旨在建立并比较一种利用移动应用程序（PEG 应用程序）和即时通讯软件的 PEG 跟踪系统与基于纸质的健康教育计划和即时通讯软件的健康教育计划。评估它们在预防并发症、避免住院再入院、改善自我护理实践和提高生活质量结果方面的效果。
采用随机对照试验设计，研究样本包括来自中国台湾中部一家医疗中心接受胸部手术或胃肠病学手术的患者。纳入标准为首次接受胃管插入的新病例且能够操作智能手机。排除标准为需要更换胃管或鼻胃管的病例。共有 74 名参与者入组，实验组 37 名，对照组 37 名。数据收集从住院到出院后 1 个月进行。实验组接受胃管跟踪系统（PEG 应用程序）和 Line 应用程序的护理，该应用程序具有电话、短信和照片拍摄功能，而对照组接受常规护理并使用 Line 应用程序。
实验组与对照组相比，并发症的发生率显著降低（χ²=12.087，P=.001）。具体来说，实验组的渗漏发生率明显低于对照组（χ²=12.906，P=.001）。然而，实验组的自我护理能力明显优于对照组（t=2.203，P=.03）。实验组和对照组的总体生活质量评分无显著差异（t=1.603，P=.11）。然而，实验组在生活质量的社会方面表现优于对照组（t=2.164，P=.03）。
将 PEG 应用程序与即时通讯相结合可以提高自我护理能力，改善生活质量的社会方面，并减少并发症。研究结果表明，PEG 应用程序可作为促进患者在家中自我管理胃管的辅助工具，尤其适用于首次接受 PEG 置管并出院的患者。
中国临床试验注册中心 ChiCTR2300071271；https://tinyurl.com/4vvy584e。
