What is a percutaneous endoscopic gastrostomy?

Percutaneous endoscopic gastrostomy (PEG) is a procedure to make an opening between the skin of your belly and your stomach. The doctor will put a thin tube, called a gastrostomy tube, into your stomach through the opening. This tube is sometimes called a G-tube, a PEG tube or a feeding tube. The tube can disperse liquid nutrition, fluid and medicines directly into your stomach. It may also drain liquid or air from the stomach.

The doctor will put a thin, lighted tube (scope) into your mouth. The scope guides the feeding tube to the stomach. The doctor will pull the end of the feeding tube through an incision in your belly. This end of the tube stays outside the body. You will probably be able to go home on the day of the procedure or the day after. Before you go home, your doctor or nurse will teach you how to use and care for your feeding tube.

How do you prepare for the procedure?

Procedures can be stressful. This information will help you understand what you can expect and help you safely prepare for your procedure.

Preparing for the Procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don't have one, you may want to prepare one. It lets others know your health care wishes. It's a good thing to have before any surgery or procedure.

What happens on the day of the procedure?

Follow the instructions on when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.

• Take a bath or shower before you come in for your procedure. Do not apply lotions, perfumes, deodorants or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry, piercings and contact lenses, if you wear them.

At the Hospital or Surgery Center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep, or it may just numb the area being worked on.
• The procedure will take about 30 minutes.
• After the procedure, you will have a feeding tube coming out of the incision in your belly. You may have gauze around the incision. You may have a plastic bag attached to the end of your feeding tube. The bag will be removed before you go home.

When should you call your doctor?

• If you have questions or concerns.
• You don't understand how to prepare for your procedure.
• You become ill before the procedure (such as fever, flu, or a cold).
• You need to reschedule or have changed your mind about having the procedure.

What is tube feeding?

Your body needs nutrition to stay strong and help you live a healthy life. If you're unable to eat, or if you have an illness that makes it hard to swallow food, you may need a feeding tube. The tube is placed in the stomach and is used to give food, liquids and medicines.

Depending on why you need a feeding tube, you may have it for several weeks, months, or even longer.

When you first get a feeding tube, your biggest challenge may be your new relationship with food. For many people, eating and savoring food is one of the most pleasing parts of daily life. You may grieve the loss of the daily habit of eating and the social aspects of sharing food with others.

If you've struggled to get enough nutrition—if it's been hard to eat or swallow—having a feeding tube can help you regain your health and strength. Understanding how a feeding tube works is the first step toward dealing with changes that come with having the tube. It can also help you avoid common problems that can occur.

What can you expect when you have a feeding tube?

After surgery to insert a feeding tube, you'll have a six to 12-inch tube coming out of your belly. The tube is about the same width as a pen. There are different ways the tube can be used for feeding. Your doctor will help you decide which is best for you and how often feedings should occur.

A Feeding Syringe

A syringe is connected to the tube. A nutritional mixture (formula) is put into the syringe and flows into the tube and your stomach. This is called bolus feeding.

A Gravity Bag

Formula is placed into a special bag that is hung on a hook or a pole. The height and weight of the bag make the food flow down the tube and into your stomach.

A Bag and Pump

A pump is used to push formula from a bag through the tube. This is also called continuous feeding.

How do you use a feeding tube?

The food you use for tube feeding must have the right blend of nutrients for you. The food also needs to be the correct thickness so the tube doesn't clog. For most people, a liquid formula that you can buy in a can works best for tube feeding. Your doctor or dietitian will help you find the right formula to use.

Each time you use the tube for feeding:

• Make sure that the tube-feeding formula is at room temperature.
• Wash your hands before you handle the tube and formula. Wash the top of the can of formula before you open it.
• Follow your doctor's instructions for how much formula to use for each feeding.
  • If using a feeding syringe: Connect the syringe to the tube and put the formula into the syringe. Hold the syringe up high so the formula flows into the tube. Use the plunger on the syringe to gently push any remaining formula into the tube.
  • If using a gravity bag: Connect the bag to the tube and add the formula to the bag. Hang the bag on a hook or pole about 18 inches above the stomach. Depending on the type of formula, the food may take a few hours to flow through the tube. Ask your doctor what you can expect and how long it should take.
  • If using a bag and pump, follow the instructions that come with the pump.
• Flush the tube with warm water before and after feedings or before and after giving medicines through the tube. You can use a syringe to push water through the tube.
• Sit up or keep your head up during the feeding and for 30 to 60 minutes after.
• If you feel sick to your stomach or have stomach cramps during the feeding, slow the rate at which the formula comes through the tube. Then, slowly increase the rate as you can manage it.
• Keep the formula in the refrigerator after you open it. Follow your doctor's instructions about how long the formula can sit out at room temperature. Throw away any open cans of food after 24 hours, even if they have been refrigerated.
• Talk with your doctor about changing your feedings or medicines if you are having problems with diarrhea, constipation or vomiting.

How do you care for a feeding tube?

• Keep it clean. That's the most important thing you need to know about caring for your tube. Flush the tube with warm water before and after feedings or giving medicines. You can use a syringe to push water through the tube. Clean the end (opening) of the tube every day with an antiseptic wipe.
• Always wash your hands before touching the tube.
• Tape the tube to your body so the end is facing up. Look for medical tape in your local drugstore. It may irritate your skin less than other types of tape. Change the position of the tape every few days.
• Clamp the tube when you're not using it. Put the clamp close to your body so that food and liquids don't run down the tube.
• Keep the skin around the tube clean and dry.

How do you avoid problems with a feeding tube?

Blocked tube
A blocked tube can happen when the tube isn't flushed or when formula or medicines are too thick.

• Prevent blockage by flushing the tube with warm water before and after using the tube.
• If the tube is blocked, try to clear it by flushing the tube. Call your doctor if the tube won't clear.
• Don't use a wire or anything else to try to unclog a tube. A wire can poke a hole in the tube.

Tube Falls Out
Don't try to put the tube back in by yourself. Call your doctor right away. The tube needs to be replaced before the opening in your belly closes, which can happen within hours.

Leaking Tube
A tube that leaks may be blocked, or it may not fit right. After checking the tube and flushing it to make sure that the tube isn't blocked, call your doctor.

Where can you learn more?

Go to https://www.healthwise.net/patientEd
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