What You Need to Know About PEG Tubes

A percutaneous endoscopic gastrostomy is a procedure in which a flexible feeding tube, called a PEG tube, is inserted through the abdominal wall and into the stomach. For patients who are not able to swallow food on their own, a PEG tube allows nutrition, fluids, and medications to be delivered directly into the stomach, eliminating the need to swallow by bypassing the mouth and esophagus.

Who May Benefit

Feeding tubes are helpful for people who are unable to feed themselves as a result of an acute illness or surgery, but who otherwise have a reasonable chance to recover. They are also helpful for people who are temporarily or permanently unable to swallow but who otherwise have normal or near-normal physical function.

In such instances, feeding tubes may serve as the only way to provide much-needed nutrients and/or medications. This is known as enteral nutrition.

Some common reasons why a person would need a feeding tube include:

  • Trouble swallowing due to weakness or paralysis from a brain injury or a stroke
  • Cancer involving the head or neck muscles, which interferes with swallowing
  • Being unable to purposefully control muscles due to a coma or a serious neurological condition
  • Chronic loss of appetite due to severe illness such as cancer

Advantages of a PEG tube for these patients include:

  • Improved energy as a result of getting proper nutrition
  • Ability to maintain a healthy weight due to getting an adequate number of calories
  • Specialized nutrition for a patient's specific needs
  • A stronger immune system resulting from improved overall health
Woman in a hospital bed with a feeding tube
Sue Barr / Getty Images 

How to Prepare

Before you undergo a gastrostomy, your healthcare provider will need to know if you have any chronic health conditions (such as high blood pressure) or allergies and which medications you take. You may need to stop certain medications, such as blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) until after the procedure to minimize the risk of bleeding.

You will not be able to eat or drink for eight hours prior to the surgery and should arrange for someone to pick you up and drive you home.

Other Types of Feeding Tubes

There are three other types of feeding tubes in addition to the PEG tube. These include:

  • Nasogastric tube (NG tube): This is among the least invasive types of feeding tubes and is only used temporarily. NG tubes are thin and are inserted into a nostril, then threaded through the esophagus and into the stomach. The outer portion is generally kept in position with tape that is placed on the nose. NG tubes can become clogged, requiring replacement with a new tube every few days, but they are easy to remove. Long-term use of NG tubes has been associated with sinusitis and other infections.
  • Orogastric (OG) tube: An orogastric tube is like a nasogastric tube, except that it is inserted into the mouth instead of the nostril. This tube can remain in place for up to two weeks, when it must be removed or replaced with a permanent tube.
  • Jejunostomy tube (J tube or PEJ tube): A jejunostomy tube is similar to a PEG tube, but its tip lies inside the small intestine, thus bypassing the stomach. It is mainly used for people whose stomach cannot effectively move food down into the intestine due to weakened motility.

If a person cannot eat and a feeding tube is not an option, then fluids, calories, and nutrients needed to survive are provided intravenously. Generally, getting calories and nutrients into the stomach or into the intestine is the best way for people to get the nutrients needed for the body to function optimally, and therefore a feeding tube provides better nutrition than what can be provided through IV fluids.

How a PEG Tube Is Placed

Prior to the PEG placement procedure, you will be given an intravenous sedative and local anesthesia around the incision site. You may also receive an IV antibiotic to prevent infection.

The healthcare provider will then put a lighted, flexible tube called an endoscope down your throat to help guide the actual tube placement through the wall of the stomach. A small incision is made, and a disc is placed on the inside as well as the outside of the opening in your abdomen; this opening is known as a stoma. The part of the tube that is outside the body is 6 to 12 inches long.

The entire procedure takes about 20 to 30 minutes. You are usually able to go home the same day.

After Placement

Once the procedure is finished, your surgeon will place a bandage over the incision site. You will probably have some pain around the incision area right after the procedure, or have cramps and discomfort from gas. There may also be some fluid leakage around the incision site. These side effects should decrease within 24 to 48 hours. Typically, you can remove the bandage after a day or two.

Your healthcare provider will tell you when it is OK to shower or bathe.

Living with a PEG Tube

It takes time to adjust to a feeding tube. If you need the tube because you are not able to swallow, you will not be able to eat and drink through your mouth. (Rarely, people with PEG tubes can still eat via the mouth.) Products designed for tube feeding are formulated to provide all the nutrients you'll need.

When you're not using it, you can tape the tube to your belly using medical tape. The plug or cap on the end of the tube will prevent any formula from leaking onto your clothes.

How to Receive Nutrition

After the area around your feeding tube heals, you'll meet with a nutritionist or dietitian who will show you how to use the PEG tube and start you on enteral nutrition. Here are the steps you will follow when using your PEG tube:

  1. Wash your hands before you handle the tube and formula.
  2. Sit up straight.
  3. Open the cap on the end of the tube.
  4. If you are using a feeding syringe, connect it to the tube and fill the syringe with the formula (which should be at room temperature).
  5. 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.
  6. If you are 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 with this method.
  7. Sit up during the feeding and for 60 minutes afterward.

Complications

Having a PEG tube comes with the risk of certain complications. These include:

  • Pain around the insertion site
  • Leakage of stomach contents around the tube site
  • Malfunction or dislodgment of the tube
  • Infection of the tube site
  • Aspiration (inhalation of gastric contents into the lungs)
  • Bleeding and perforation of the bowel wall

Difficult Decisions

In some instances, it can be hard to decide whether giving a person a feeding tube is the right thing to do and what the ethical considerations are. Examples of these situations include:

  • When a person is in a coma due to a progressive and fatal disease (such as metastatic cancer) that is expected to cause death very soon. Some family members may feel that a feeding tube can prolong life for only a few days and may also lead to excessive pain and discomfort for the dying and unresponsive loved one.
  • When a person is unable to express personal wishes due to the impact of disease but had previously stated to loved ones that they would not want to be fed through a feeding tube. This can be a difficult problem when some, but not all, family members are aware of their loved one's wishes, but the wishes are not written or documented anywhere.
  • When a person is in a coma, with extensive and irreversible brain damage and no meaningful chance to recover, but could be kept alive indefinitely with artificial feedings.
  • When a person has signed a living will that specifies they would never want to be fed through a feeding tube, but the medical team and family have reason to believe that there is a chance of recovery if nutritional support is provided.

Outlook

If you or your loved one has a serious illness that prevents eating by mouth, a PEG tube can temporarily, or even permanently, provide calories and nutrients for the body to heal and thrive.

PEG tubes can last for months or years. If necessary, your healthcare provider can easily remove or replace a tube without sedatives or anesthesia, by using firm traction. Once the tube is removed, the opening in your abdomen closes quickly (hence if it falls out accidentally, you should call your healthcare provider immediately.)

Whether tube feeding improves quality of life (QoL) depends on the reason for the tube and the condition of the patient. A 2016 study looked at 100 patients who had received a feeding tube. Three months later, the patients and/or caregivers were interviewed. The authors concluded that while the tubes didn't improve QoL for patients, their QoL didn't decrease.

Frequently Asked Questions

How do you check PEG tube placement?

The tube will have a mark that shows where it should be level with the opening in your abdominal wall. This can help you confirm that the tube is in the correct position.

How do you clean a PEG tube?

You clean a PEG tube by flushing warm water through the tube with a syringe before and after feeding or receiving medications and cleaning the end with an antiseptic wipe.

How do you unclog a PEG tube?

First, try to flush the tube as you normally do before and after feedings. A blockage can occur if the tube isn't flushed or if the feeding formula is too thick. If the tube won't clear, call your healthcare provider. Never use a wire or anything else to try to unclog the tube.

How do you stop a PEG tube from leaking?

A leaking tube may be blocked. Try flushing it. If that doesn't work, call your healthcare provider.

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10 Sources
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