Percutaneous Endoscopic Gastrostomy

WHAT YOU SHOULD KNOW:

Percutaneous Endoscopic Gastrostomy (Inpatient Care) Care Guide

  • Percutaneous endoscopic gastrostomy (PEG) is a procedure to place a soft, plastic feeding tube into your stomach. You may need a PEG tube if you cannot get enough nutrition eating food by mouth. Without enough nutrition, you may lose too much weight and become dehydrated (loss of body fluids). Formula (liquid food) can be given through the tube to give your body the nutrition it needs. The tube may also be used for decompressing (removing air and fluid) your stomach. Your caregiver uses an incision (cut) and an endoscope to insert the PEG tube into your stomach. An endoscope is a small, bendable tube with a light and camera on its tip. One end of the PEG tube is inside your stomach, and the other end is secured on your abdomen. Your abdomen is a cavity (space) that holds many organs, such as your stomach, intestines (bowels), and liver.



  • You may have trouble eating if you have cancer in your mouth or esophagus (food pipe). Medical conditions, such as a stroke or other brain and nerve problems, may cause trouble swallowing. You may also have trouble swallowing from an injury or a serious (very bad) burn. You may need a PEG tube for decompression if your stomach does not empty on its own. You may need your PEG tube for a short time, or for the rest of your life. A PEG tube used for decompression may stop nausea (upset stomach) and vomiting (throwing up). A PEG tube may prevent loss of body weight and dehydration. A PEG tube may allow your body to get the nutrition it needs to function.

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.

RISKS:

  • The anesthesia medicine used for your procedure may cause your blood pressure to drop too low. During your procedure, the endoscope may damage your esophagus, stomach, or nearby organs and tissues. Damage to your organs or tissues may cause bleeding in, and behind, your abdominal cavity. If you have esophageal cancer, the endoscope may spread cancer cells to the PEG tube site. During or after the procedure, liquid from your stomach may enter your lungs, causing a lung infection. Excess air or gas may collect in your abdominal cavity. After your procedure, you may have bruising around your stoma, and your stoma may be painful. The skin around your PEG tube may break open or blister, and tissue may grow over your tube.

  • Your PEG tube may become buried in your skin or move out of place. Formula used for feeding may leak out of your stoma. Your PEG tube may become blocked and it may crack, break, or leak. Your stomach may have trouble emptying into your bowel. A fistula (abnormal tissue opening) may form between your skin and your stomach or your colon. Your wound may become infected, and you may get an abscess (pus pocket) near your wound. You may get an infection in your abdomen or nearby tissues, or you may get a life-threatening blood infection.

  • If you do not get a PEG tube for decompression, your stomach may not empty properly. Liquids from your stomach may enter your lungs and cause a lung infection. If you do not have a PEG feeding tube placed, you may not get enough nutrition for your body. Not eating can cause dehydration. You may continue or start to lose more weight than you should. Poor nutrition and lost body weight can be life-threatening and you may die. Talk with your caregiver if you have questions or concerns about your condition, treatment, or care.

WHILE YOU ARE HERE:

Before your procedure:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

  • Antibiotic medicine: Antibiotics may be given to help prevent an infection caused by germs called bacteria.

  • Pre-op care: You are taken to the procedure room and moved to a table or bed. You will lie on your back or left side with the head of the bed raised.

  • Sedation: A sedative is medicine given in your IV to help you relax or make you drowsy.

  • Local anesthesia: Local anesthesia is numbing medicine given to keep you comfortable during your procedure. Anesthetic may be sprayed into your throat so you will not have pain while the endoscope is placed. A shot of local anesthesia may be given in your abdomen to numb the procedure area. You may still feel pressure or pushing during your procedure, but you should not have pain. With local anesthesia, you are fully awake during your procedure.

During your procedure:

  • An endoscope is put in your mouth, moved down your esophagus, and into your stomach. Your caregiver looks through the endoscope to check for any abnormal areas in your stomach. Your stomach is suctioned to remove any fluid. The light on the end of the endoscope may be seen through your abdomen. The light helps your caregiver find the best place on your abdomen to insert the PEG tube. Your stomach may be filled with air or gas to help your caregiver better see inside your stomach. A small cut is made in your abdomen. A needle catheter (tube) is put through your skin and into your stomach. A wire is threaded through the catheter and grabbed through the end of the endoscope. The wire is pulled through the endoscope and out of your mouth.

  • A caregiver will attach the PEG tube to the wire. The PEG tube is pulled back through the endoscope and into your stomach. Inside your stomach, one end of the tube will be held in place with a bumper (attached plastic). Your caregiver removes the endoscope. The other end of the PEG tube is pulled out through the cut in your abdomen. The opening in your abdomen where your PEG tube comes through is called a stoma. The wire is removed, and the tube is secured on your abdomen with a bumper. Your caregiver may insert the endoscope again to check the placement of your PEG tube.

  • Your caregiver may not use an endoscope if you have a blockage or cancer in your throat or esophagus. Your caregiver places the PEG tube directly into your stomach through a cut in your abdomen. This may also be done if the endoscope light cannot be seen when choosing the best PEG site. Your caregiver uses an ultrasound as a guide during the procedure. An ultrasound is a test that uses sound waves to show the inside of your body on a screen. The tube is held in place with a small inflated (blown up) balloon on the inside of your stomach.

After your procedure:

  • You are taken to a room to rest until you are fully awake and any numbness is gone. Do not get out of bed until your caregiver says it is okay. When caregivers see that you are not having any problems, you may be able to go home. You may get your first PEG tube feeding before leaving the hospital. If you are staying in the hospital, you will be taken to your room.

  • Before leaving the hospital, caregivers will teach you how to use your PEG tube. If someone helps you with your care, the person should be included in any PEG tube teaching. You may also be seen by a nutrition caregiver to talk about your tube feedings.

© 2013 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.

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.

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