How To Use And Care For Your Peg Tube

What is a PEG tube?

A percutaneous endoscopic gastrostomy (PEG) tube is a soft, plastic tube that is put into your stomach through your skin. You may need your PEG tube until you can swallow food and water again, or you may always need it.

Why do I need a PEG tube?

  • Feeding: If you are not able to eat or drink, the PEG tube is used to give you food and liquids. It may help you gain weight you have lost or need to gain. Most often PEG tubes are put in for feeding.

  • Decompression: A PEG tube may be used for decompression. Decompression is when air or liquid is let out of your stomach and intestines to reduce the pressure. You may need a PEG tube if you have a bowel obstruction. The tube can help decrease your vomiting and stomach pain.

What formulas are used for PEG tube feedings?

The following are types of formulas that may be used:

  • Ready-made formula: All ready-made formulas contain carbohydrates, fats, proteins, and water. Certain formulas may be lactose-free, gluten-free, or low in fat or sugar. Some formulas are made for a specific disease, condition, or treatment. Ask your caregiver which kind of formula is right for you.

  • Blenderized formula: In some situations, you may be able to use a blenderized formula. This type of formula made from pureed foods. You must have a larger feeding tube to use blenderized formula. This is because the thickness of these formulas increases the risk that your tube will get clogged. Blenderized formulas are can be bought ready-made, or you can make it at home. The ready-made blenderized formulas have added vitamins and minerals. Compared to ready-made formulas, home blenderized formulas are not sterile (germ-free) and may not have all of the nutrition that your body needs. Ask your caregiver if you can use blenderized formula.

What other things may be given though my PEG tube?

Your PEG tube may also be used to give you:

  • Medicines: These are the medicines that you would usually take by mouth.

  • Extra water: Although the formula has water in it, you may need extra water to keep from getting dehydrated. You may need more water when you are sweating, such as during hot weather or if you have a fever. You may also need more water if you have diarrhea or if you are vomiting. Ask your caregiver how much extra water you may need.

  • Flush water: This is water used to clear formula or medicine from your PEG tube after you have been fed or given medicine.

When and how often do I use my PEG tube for feedings?

Your caregiver will tell you when to start using your PEG tube for feedings. Ask your caregiver how often you will need tube feedings. You may need bolus, intermittent, or continuous tube feedings. Between bolus and intermittent feedings, follow your caregiver's directions for flushing your PEG tube.

  • Bolus feedings: A bolus feeding is an amount of formula given over a short period of time.

  • Intermittent feedings: Intermittent feedings are scheduled for certain times.

  • Continuous feedings: Continuous feedings are given all the time.

How do I give formula through the PEG tube?

Your caregiver will decide the method you should use to give formula through your PEG tube. You may use a feeding syringe, a gravity bag system, or a bag system with an electric pump.

  • Feeding syringe: Connect the feeding syringe to the end of the PEG tube. Pour the correct amount of formula into the syringe. Hold the syringe up high. Formula will flow into the PEG tube. The syringe plunger may be used to gently push the last of the formula through the PEG tube.

  • Gravity drip bag: Connect the tubing from the gravity drip bag to the end of the PEG tube. Pour the formula into a gravity drip bag. Hang the bag on a medical pole, a hanger, or other device. Adjust the flow rate on the tubing according to your caregiver's instructions. Formula will flow into the PEG tube. Ask your caregiver how long it should take to complete your feeding.

  • Feeding pump: You may use an electric pump to control the flow of the formula into your PEG tube. Caregivers will teach you how to set up and use the pump.

What are the signs and symptoms that I am not tolerating my PEG tube feedings?

If you have any of the following signs, your caregiver may change your feedings or medicines:

  • Diarrhea

  • Stomach bloating and cramping

  • Nausea (sick to your stomach) and vomiting

How do I care for my PEG tube?

Ask caregivers to show you how to care for your PEG tube.

  • Flush your PEG tube: You always need to flush your PEG tube before and after each use. Flush your PEG tube to help keep it from getting clogged with formula or medicine. Ask your caregiver if you should use tap water, bottled water, or sterile water for flushing your tube. Usually at least 30 milliliters (mL) or about 2 tablespoons of water is used to flush the tube. Follow your caregiver's directions for flushing your PEG tube.

  • Check the PEG tube daily:

    • Tube length: Check your PEG tube often to see if the length of it has changed. Check the length of the tube from the end to where it goes into your body. If it gets longer, it may be at risk for coming out. If it gets shorter, let your caregiver know right away.

    • Bumper tightness: Check the bumper (piece that goes around the tube, next to your skin). It should be snug against your skin. Tell your caregiver if the bumper seems too tight or too loose.

  • Keep the hub of your PEG tube clean:

    • Connecting and disconnecting: When you disconnect your PEG tube from a syringe or tubing, do not let the end of the PEG tube touch anything. Use a new alcohol pad to wipe off the end of the PEG tube. Do this before you connect anything to your PEG tube and after you disconnect anything from your PEG tube.

    • Daily tube cleaning: Clean the hub (tube opening) of your PEG tube daily. This is where the feeding equipment attaches to the PEG tube. Ask your caregiver what you should use to clean the tube hub.

  • Check the PEG tube for clogs: Formula or medicines can clog your PEG tube. Try to unclog your PEG tube as soon as you notice the problem. Try flushing your PEG tube with a 60 milliliter (mL) syringe filled with warm water. Ask your caregiver what to do if your PEG tube gets clogged.

    • Never use a wire to unclog the tube. A wire can poke a hole in the tube.

    • Your caregiver may have you use a special medicine or a plastic brush to help unclog your tube.

How do I care for the skin around my PEG tube?

Ask caregivers to show you how to care for the skin around your PEG tube.

  • After you first get your PEG tube: Do not remove the stitches or pieces of tape that hold your PEG tube in place. Your caregiver will take them off once the skin around your tube heals. Leave clean bandages over the tube area for the first 24 hours after the tube is put in. You may not need to use bandages after 24 hours if the skin around the tube looks dry. Ask your caregiver when you can shower or bathe again.

  • Routine skin care:

    • Clean your skin daily: Clean the skin around your tube 1 to 2 times each day. Ask your caregiver what you should use to clean your skin. Check for redness and swelling in the area where the tube goes into your body. Check for fluid draining from your stoma (the hole where the tube was put in).

    • Turn your tube daily: If there are no stitches holding your PEG tube in place, gently turn the tube. This may decrease pressure on your skin under the bumper. It may also help prevent an infection. Ask your caregiver how to turn your PEG tube correctly.

    • Keep your skin dry: Keep the skin around your PEG tube dry.

  • Use skin medicines as directed: You may need to put barrier or antibiotic (germ-killing) cream on the skin around your tube after you are done cleaning it. If your skin gets infected, your caregiver may give you antibiotic medicine to take as pills.

When is a PEG tube replaced?

  • Your PEG tube comes out. You will need to have the tube replaced right away. The stoma (hole) where the tube goes into your stomach can start to close up quickly. This can happen within 2 hours after your tube comes out.

  • A clog in your PEG tube cannot be cleared. The tube will need to be replaced immediately.

  • You have problems with your stoma. Caregivers may need to put the tube into a different place in your stomach.

  • Your PEG tube is old. You may need a new PEG tube every 1 to 2 years.

What other problems can happen when I have a PEG tube?

  • When you get tube feedings, your medicines may not work as they should. You can get dehydrated. You may not get all the minerals that you need. You can get constipated. This is when you have bowel movements that are hard and dry less often than usual. Your blood sugar can go too high or too low. High blood sugar increases your risk of infection. You could feel discomfort or pain around the area where your PEG tube is placed.

  • The skin around your tube can get infected. You can get sick if germs get into your body through the stoma or tube. Formula or water can get into your lungs. The inside end of the tube can move out of place. Call your caregiver if you have questions or concerns about these risks or your PEG tube.

What else should I know about having a PEG tube?

  • Intake and output: Your caregiver may tell you to keep track of how much formula and other liquids you have every day. You may need to keep track of how much you urinate and how many times you have a bowel movement each day. Write this information down to show your caregiver during follow-up visits.

  • Weight checks: Your caregiver may tell you to check your weight daily or weekly. Write the number down to show caregivers. Your caregiver may need to change your feedings if your weight changes too quickly.

  • Take your medicines as ordered: Talk to your caregiver about your medicines. Learn which of your medicines can be crushed, mixed with water, and given through the PEG tube. Certain medicines do not work as they should if they are crushed. Other medicines may clog the PEG tube.

  • Keep all follow-up appointments: You may need to have blood tests and other tests when you see your caregiver.

When should I call my caregiver?

  • You have stomach pain after each feeding or when you move around.

  • You have diarrhea or are constipated.

  • Your mouth feels dry, your heart feels like it is beating too fast, or you feel weak.

  • Your weight changes more than what your caregiver has told you it should.

  • You have a fever.

  • The skin around your PEG tube is sore, red, or swollen, or there is pus coming out of the stoma.

  • You have formula, medicine, or drainage coming out from around your PEG tube.

  • Your symptoms do not go away with treatment.

  • Your PEG tube is longer than it was when it was put in.

  • You have questions or concerns about your PEG tube, formula, or medicine.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • You feel sick to your stomach, vomit, or your abdomen is swollen and painful.

  • You have blood coming from your PEG tube, the stoma, or your anus.

  • You have sudden abdominal pain and dizziness.

  • Your PEG tube is shorter than it was when it was put in.

  • Your PEG tube comes out.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.