Endoscopy Unit
A Guide to PEG Feeding
Your medical team has referred you to discuss having a Percutaneous Endoscopic Gastrostomy (PEG) tube. This leaflet is designed to help you decide whether or not you want the feeding tube. You should also discuss this with the doctors and ask any further questions before proceeding.
DEFINITIONS
Percutaneous = through the skin
Endoscopic = the use of an instrument called an endoscope (camera) to examine the stomach
Gastrostomy = opening in the stomach
What is a PEG tube?
A PEG tube is a feeding tube that passes through the abdominal wall into the stomach so that food, water and medication can be given without swallowing. The PEG tube is inserted during a minor operation in the endoscopy department.
Why is a PEG tube needed?
PEG tubes are used for people who have swallowing problems or who are unable to take enough food or fluid to meet their nutritional requirements.
How long does the tube last?
A PEG tube can last several years if well cared for; it may need to be replaced if needed for a long time.
How long will I require the tube?
Different people will need the tube for different periods of time. It may only be needed until your food or fluid intake improves or your swallow improves. Others may need a PEG tube for the rest of their lives. This should be discussed further with your doctors.
What are the preparations for a PEG tube?
Blood tests will have been checked beforehand to make sure your blood clots normally. If you usually receive blood thinning treatment, this will usually be stopped before the procedure.
If you are being fed by mouth or via an NG tube, the feeding needs to be stopped for at least 6-8 hours prior to the procedure.
You should be clear of acute infections prior to having the procedure.
You will be given an antibiotic beforehand.
If you have any allergies, you must let your doctor know.
You will be assessed by the anesthetist before the procedure.
The procedure will be performed in the endoscopy unit, after which you will be transferred back to your ward.
How is the PEG tube inserted?
Usually, the PEG tube is inserted under anesthesia, sometimes it can be done under sedation only, and it takes approximately 20-30 minutes. An endoscope is used to place the tube. The endoscope is passed through the mouth and throat into the stomach. A local anesthetic is injected into your skin and a small opening is made through which the PEG tube is placed. Following the procedure, you may have a sore throat and you may have some discomfort around the site of your PEG.
How is the tube used for feeding?
After insertion, the PEG tube will not be used for at least 4-6 hours. Following this period, water is given via the PEG using a pump for 4 hours and then feeding will start. The dietitian will prepare a feeding plan for you. You will receive a specially prepared liquid feed that contains all the nutrients you need in a day. You (or your relatives/ carers) will receive training to carry out feeding.
Caring for your PEG tube
A dressing will be placed around the PEG site following insertion which can be removed in one to two days. After this, the PEG site will need to be cleaned on a daily basis. After the external fixator of the shaft of the PEG tube is released, the shaft can be pushed into the stomach and turned daily. This is necessary in order to prevent the internal plug from becoming trapped within surrounding tissue. No further dressing will be routinely required. The tube will also need to be flushed daily with water to prevent blockage. Appropriate training and support regarding this will be delivered to caretakers.
What problems might occur?
Caring for your tube correctly will help to prevent problems. Possible problems may include tube blockage, skin infection, leakage around the tube, or tube displacement.
As stated above, once the tube has been in place for over 2 weeks it is important to release and turn the shaft of the tube into the stomach each day to prevent the internal bumper from becoming trapped in the surrounding tissues.
Risks associated with PEG tube?
Having a PEG tube inserted is a routine procedure with a low risk of complications. As with every procedure risks versus benefits will be discussed with you.
There is a small risk of breathing difficulties and pneumonia if food or secretions should enter the windpipe during the procedure.
There are some risks related to anesthesia which will be discussed in detail by the anesthetist. A consultant anesthetist will be monitoring you during the procedure.
While inserting the feeding tube there is a small risk of internal bleeding (hemorrhage) or puncturing of the bowel (perforation). However, you will be monitored closely during and after the procedure.
Very rarely, if the PEG tube becomes displaced or is not properly secured during the few days following the procedure there is a risk of peritonitis (inflammation of the lining of the abdominal wall).
Other possible risks and complications will be discussed with you prior to signing the consent.
