PEG feeding tubes

What is a PEG feeding tube?

A percutaneous endoscopic gastrostomy (PEG) feeding tube is a way to give food, fluids and medicines directly into the stomach by passing a thin tube through the skin and into the stomach.

• Percutaneous means through the skin.

• Endoscopic means that a small, long, thin and flexible tube (endoscope) is used to position the PEG feeding tube into the stomach.

• Gastrostomy means making an opening into the stomach.

For tube feeding over long periods of time, PEG feeding tubes are more comfortable and easier to use than a tube passed through your nose and down into your stomach (nasogastric tube). PEG feeding tubes can also be hidden under your clothes so that no one needs to know you've got one.

The PEG feeding tube has a small plastic disc inside your stomach and another small disc on top of your skin where the tube is inserted. These discs prevent the tube coming out or the whole tube ending up in your stomach.

What are the reasons for using a PEG feeding tube?

• A PEG feeding tube can be used if you have difficulty swallowing or have a problem that causes a risk of swallowed food going into your lungs rather than into your stomach. The possible causes of these problems include having a stroke or a condition that causes weakness of the muscles needed to make sure that all swallowed food ends up in the stomach rather than in the lungs.

• A PEG feeding tube can also be used if normal feeding is not enough to provide all of the body's needs. Examples of this may be for people with cystic fibrosis or if you need to have dialysis for kidney failure.

• PEG tubes may also be used for many other conditions such as bowel cancer, after a head injury, Crohn's disease or severe burns.

• A PEG feeding tube may be used for children as well as adults. A child may need a PEG feeding tube for various conditions, including any condition that causes swallowing problems.

When should a PEG feeding tube not be used?

A PEG feeding tube cannot be inserted if you have a problem with blood clotting, if you are very unwell, or if you have a severe infection. There may be other reasons why a PEG feeding tube is not a good idea for you and this can be discussed with your specialist and nurse.

How is the PEG tube inserted?

The PEG tube is usually inserted in the hospital endoscopy unit. Adults do not usually need to have a general anaesthetic but you will usually given an injection of a sedative to make you sleepy and relaxed. A local anaesthetic is used to numb the area of skin where the PEG tube is to be inserted. Children do need a general anaesthetic for the insertion of the PEG feeding tube.

You will be given an antibiotic and the area of skin over your stomach will be cleaned thoroughly to reduce the risk of any infection.

The procedure is not painful but you may feel some pressure over your stomach while the tube is being inserted. The whole procedure usually takes between 20 and 30 minutes. Feeding through the PEG tube can often be started about four hours after the tube has been inserted.

How is the PEG tube managed after insertion?

You will be shown how to use the feeding tube by nurses while you are in hospital. You must make sure you're completely happy with using the tube, so ask about anything you're not sure about.

It is very important to make sure the area of skin where the tube has been inserted (insertion site) remains free of any infection, especially during the first 10 days after the insertion. You should be given clear instructions about looking after the area where your PEG has been inserted, including washing the area with soap and water. If you think the skin may be infected or if you have any concerns then you should contact your nurse or your GP.

What are the complications?

Most people don't have any problems as a result of having a PEG tube inserted, apart from some discomfort for the first few hours after the insertion. However, minor problems can occur, such as infection around the skin where the tube has been inserted or some leakage around the tube.

Sometimes the insertion site will be uncomfortable with some pain for up to one week after the insertion. This may make you reluctant to take deep breaths but it is very important to breathe as normally as possible. This is because taking shallow breaths may increase your risk of a chest infection.

Major complications are very uncommon but include:

• Breathing problems during or after the tube is inserted.

• Bleeding.

• The tube causing a hole in the bowel (bowel perforation).

• Infection in your tummy (abdomen).

• A very small risk of death as a result of having a PEG tube inserted.

What is the outlook?

For most people with a PEG feeding tube there are no problems or side-effects when the tube is inserted and no problems with having the tube. However, the outlook (prognosis) will depend on the underlying medical condition.