Introduction
You have been advised to have a PEG tube inserted. This leaflet may not answer all your questions so if you have any worries please don’t hesitate to ask.
What is a PEG?
PEG (Percutaneous Endoscopic Gastrostomy tube)
It is a thin flexible tube, about the size of a straw, that passes through the abdomen and into the stomach.
It allows liquid food (nutrition), fluids and medication to be fed directly into the stomach.
Why do I need a PEG tube?
You may need a PEG tube because you are unable to eat or drink enough to meet your nutritional needs. Some medical conditions can cause swallowing to become difficult and there is also risk of food going the wrong way. Common indications for a PEG insertion include a Stroke, Multiple Sclerosis, Motor Neurone disease, or a cancer around the head and neck area.
Pre Assessment Appointment
Once you have a booking date you will be pre-assessed over the phone. Please ensure you have contact details of your next of kin, escort and a list of your medicines to hand. The nurse will go into detail about the procedure, check your medical history and answer any questions you may have.
On the day of the procedure
You must not have anything to eat six hours before the examination. Small amounts of water are safe up to 2 hours before the test.
If you have a morning appointment, please do not have anything to eat from midnight but you may have a drink at 6am.
If you have an afternoon appointment please take your regular medication with a light breakfast no later than 8am and small amounts of water until 2 hours before your appointment
When you arrive at Reception you will be asked to take a seat to wait to be called by the admissions nurse. We ask you not to turn up early due to space constraints. Once in admissions they will explain the procedure and go through your pre assessment to make sure there have been no changes in your health. You will then be asked to get changed and prepared to see the Endoscopist. The Endoscopist will go through a consent form with you and ask you to sign it. This is to ensure you understand the procedure and its implications. If you have any worries or questions don’t be afraid to ask. The staff want you to be relaxed as possible for the procedure and will not mind answering your queries.
A nurse will insert a small (needle) cannula into your vein in your hand or arm. This will enable the Endoscopist to administer the sedation.
What happens during the procedure?
Once in the treatment room, the nurse looking after you will ask you some safety questions and help to position you correctly for the procedure and will stay at the head of your bed. The nurse may suction the saliva from your mouth if required. A plastic mouth guard will be put into your mouth to protect your teeth. You will then be given sedation. Some Endoscopists like to use throat spray to numb the throat.
An Endoscopist passes a Gastroscope into the stomach, air is passed into the stomach via the scope, and the area is illuminated. The correct point of insertion of PEG is identified.
The assisting Doctor will clean the area, administer the local anesthetic and make a small incision and insert a tube and a thread into the abdomen. This thread is then caught using grasping forceps (cold snare) and it is pulled out through the mouth as the scope is removed.
The actual PEG tube is then attached to the thread and is pulled back through the mouth using the attachment at the abdomen site, until it is pulled right through the incision onto the outside of the abdomen.
There is a flange (small disc), about the size of a ten pence piece, that sits on the wall of the abdomen to ensure the PEG does not fall out. There is also a small plastic fixator device, the shape of a triangle, that sits on the outside of the abdomen also ensuring that the PEG stays in place.
The whole process takes about 30 minutes.
You will rest on a trolley until you are more awake, sedation has worn off and the nurses are happy with your progress.
The Endoscopist will decide whether you require an overnight stay in hospital for observation. If not we will keep you in the department for about 4 hours. We can give you a booklet on caring for your P.E.G tube at home. The hospital dietician will be advised of your admission.
If you have sedation for any procedure and you are going home on the same day, it is essential that a responsible adult stays with you for 12 hours afterwards. Do not drive, operate machinery, drink alcohol, sign any legal binding document or look after small children or other dependents for 24 hours after sedation.
Risks
- Bleeding
- Infection – usually mild and affects only the skin around the PEG site (risk: 1 in 10). Infection of the tissues of the abdomen (risk: 1 in 1000).
- Chest infection – risk is higher if you have swallowing problems, need sedation and suffer from reflux.
- Perforation – a small risk of a perforation (tear) either from the scope or the tube. You may need further treatment which may include surgery.
- Peritonitis – Inflammation of the lining of the abdomen. Can be treated with antibiotics and settles within 2-3 days. Feeding through the tube may be delayed
- Damage to dental work – a mouth guard is used to protect your teeth
After your procedure
You will be continually monitored and allowed to rest for about 4 hours in the recovery area. You may feel a little bloated with wind pains but these usually settle quite quickly. Once you have recovered, you will be assessed by the Nurse to see if you are able to go home. Sometimes we do advise you to stay in hospital for one to two days after your procedure for observation. If you are able to go home you will be assisted off the trolley, the cannula will be removed and you will be able to get dressed.
The doctor will advise when you may start feeding and taking anything by mouth.
Your nutritional support nurse in the community can help you with any ongoing care.
A report will be sent to your GP informing them of the outcome of your visit to Endoscopy.
A nurse will go through the discharge information, this includes receiving a clear post procedure leaflet and then you will be escorted to the discharge lounge and given refreshments.
Going home
If you are going home after the test it is essential that a responsible adult comes to the department to pick you up and stays with you for 24 hours.
Once home, it is important to rest quietly for the remainder of the day. The effects of the procedure and the sedation should have worn off by the next day; however the effects of the sedation can last for 24 hours, so for this time you must not:
- Drive a car;
- Operate machinery;
- Drink alcohol;
- Sign any legal documents; or
- Be responsible for small children.
You are advised against foreign/remote travel in the 2 week period after this procedure.
Results
Before you leave the department, a nurse or doctor will explain the outcome of your procedure and discuss any changes of medication and further investigations or appointments you may require. Due to the effects of the sedation, many people find they forget everything that has been said to them. This is why we give written information as well as verbal.
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.
(Day time contact the hospital and ask to speak to the dieticians. After 5pm please attend the accident and emergency department.)
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)