You have been advised to have a PEG tube replaced. This leaflet may not answer all your questions so if you have any worries please don’t hesitate to ask. The staff who are doing the test will be available to answer any queries.
Your Freka P.E.G tube is due for replacement in the endoscopy department.
Hopefully you will have discussed the options available to you prior to your visit to us. We aim to provide the safest and most suitable procedure for your needs and hope this information helps you.
Before you arrive
Do not eat, drink, chew gum or use your P.E.G for at least six hours before your appointment.
If you are taking Warfarin, Clopidogrel or any other drugs by mouth or injection that interfere with blood clotting, it is important that you tell us, as you may need to stop these for a few days before your appointment with us. Please also write down a list of any medication you take and remove all nail varnish.
When you arrive
Our receptionist will greet you and a nurse will talk to you and answer any questions you may have. Please feel free to ask at any time. You will have your blood pressure and other observations taken – this is routine for all our patients. We may ask you to undress and wear a hospital gown or loosen your clothing as appropriate.
Types of replacement tubes and methods
A new Freka PEG tube – same stoma site
- This is when the doctor passes a gastroscope through your mouth into your stomach which is inflated with air. (Similar procedure to your first P.E.G. insertion). The procedure will be explained fully to you and you will be asked to sign a consent form when you are ready.
- The procedure is usually done after giving you a sedative injection to help relax you or in some cases a local anaesthetic sprayed to the back of the throat to make it numb. small bumper (flange), remaining in your stomach will be left there to be passed in your stools. Patients are carefully selected for this method as there is a very small risk of the bumper (flange) causing blockage in the bowel – but this is rare.
- Whenever possible the doctor will pass the new Freka tube into the same site as your present one so that you can use your tube as soon as possible.
A new Freka PEG tube- new site
- If it isn’t possible to use the same site, the doctor will select a different area of your stomach.
- You will be given an injection of antibiotics before the procedure and sedation to relax you. After removal of your present tube, a dressing will be applied to contain any leakage from the stoma site. A gastroscopy is performed and local anaesthetic injected where the new tube will be, to numb your skin.
- This procedure will be the same as your first P.E.G insertion and because this is a new area of the stomach you must not use the tube or have anything by mouth for four hours after it is inserted. All the precautions for a new P.E.G. will apply and it is advisable to stay overnight in hospital for observation. We can give you a booklet on caring for your new Freka P.E.G tube at home. The hospital dietician will be advised of your admission.
Balloon replacement tube
- This is generally the simplest procedure and gastroscopy may not be required. After removal of your present Freka P.E.G, the new tube is lubricated and gently pushed into the stomach through the same site. It is prevented from falling out by injecting a small amount of sterile water into a balloon which sits on the inside of the stomach. (The same idea as a catheter in the bladder). You will be able to use the tube for flushing, feeding, fluids and medicines as soon as you are ready.
Risks
Most P.E.G removals and replacements are straightforward. However occasionally we may find the bumper (flange) is stuck in your stomach and cannot be removed at endoscopy. A different procedure may be required at a later date to remove it.
There is a small risk of minor side effects during and after removal and replacement. You may have a sore throat or wind afterwards but this should settle soon. Rare complications include: reactions to medication, bleeding, perforation (making a hole) and blockage in the bowel.
After your procedure
If you have had a gastroscopy with sedative injection, you will rest on a trolley until you are more awake and the nurses are happy with your progress.
If you have had a local anaesthetic throat spray, recovery will be quicker. The doctor will advise when you may start feeding and taking anything by mouth.
When a balloon replacement is inserted, we will explain the care it requires and give you a spare to take with you. It will need to be replaced in three months’ time at home. Your nutrition support nurse in the community can help you with any ongoing care.
If a new Freka P.E.G has been inserted in a new site it is likely to be uncomfortable at first and you may need painkillers. It is important not to immerse the site in water for two weeks – to prevent infection. The previous P.E.G site needs time to heal so try not to undertake any strenuous activity for a week.
A report will be sent to your GP informing them of the outcome of your visit to endoscopy.
Things to report to your doctor
- Severe pain in chest, stomach or abdomen – Do not feed
- Passing or vomiting blood
- Passing black stools
- Temperature greater than 100°F/39°C
- Signs of infection at P.E.G site – pain/redness/discharge
- Redness, tenderness & swelling at your injection site that persists more than 48 hours
If your tube falls out seek advice straight away as the opening will start to close quickly.
Points to remember
- If you are unable to keep your appointment please notify the Endoscopy unit as soon as possible
- It is our aim for you be seen and investigated as soon as possible after your arrival. However the department is busy and your investigation may be delayed. If emergencies occur, these patients will obviously be given priority over less urgent cases.
- The hospital cannot accept any responsibility for the loss or damage of personal property during your time on these premises.
Concerns
If you have any queries regarding the procedure please contact the endoscopy unit between 8am and 6pm Monday to Sunday and the nursing staff will be happy to give you information or advice.
FOLLOWING THIS PROCEDURE YOU MUST NOT DONATE BLOOD FOR 4-6 MONTHS
The reason for this is that your ability to donate blood in the future is dependent upon your diagnosis and the possibility that you might need to undergo further investigations or complete treatments. (British Society of Gastroenterology, 2019)