Percutaneous Endoscopic Gastrostomy Insertion In Children
WHAT YOU SHOULD KNOW:
- Percutaneous endoscopic gastrostomy (PEG) insertion is a procedure to place a plastic feeding tube into your child's stomach. Your child may need a PEG tube if he cannot get enough nutrition eating food by mouth. Without enough nutrition, your child may lose too much weight, and stop growing. Your child may also become dehydrated (lose body fluids). Formula (liquid food) given through the PEG tube can give your child's body the nutrition it needs. The tube may also be used to decompress (remove air and fluid) your child's stomach. Your child may need decompression if his stomach does not empty well on its own.
- Your child may have trouble getting enough nutrition if he has problems swallowing. A PEG feeding tube may decrease your child's risk for choking. Medical conditions, such as cerebral palsy or cancer in the mouth or esophagus (food pipe), may cause swallowing problems. Your child may have an injury that causes swallowing problems. Your child may need a PEG feeding tube if he has gastroesophageal reflux (GER). With GER, stomach acid backs up into your child's esophagus, causing damage. A PEG feeding tube may also be needed if your child has Crohn's disease, HIV, or kidney failure.
- Your child's caregiver uses an incision (cut) and an endoscope to insert the PEG tube into the 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 child's stomach, and the other end is secured on his abdomen. Your child's abdomen is a cavity (space) that holds many organs, such as the stomach, intestines (bowels), and liver. Your child may need a PEG tube for a short time, or for the rest of his life. A PEG tube used for decompression may stop nausea (upset stomach) and vomiting (throwing up). A PEG tube may prevent weight loss and dehydration. A PEG tube may allow your child to get the nutrition his body needs to function.
- Keep a current list of your child's medicines: Include the amounts, and when, how, and why they are taken. Bring the list and the medicines in their containers to follow-up visits. Carry your child's medicine list with you in case of an emergency. Throw away old medicine lists. Give vitamins, herbs, or food supplements only as directed.
- Give your child's medicine as directed: Call your child's primary healthcare provider if you think the medicine is not working as expected. Tell him if your child is allergic to any medicine. Ask before you change or stop giving your child his medicines.
- Antiulcer medicine: This medicine helps decrease the amount of acid that is normally made by the stomach.
Ask for more information about where and when to take your child for follow-up visits:
For continuing care, treatments, or home services for your child, ask for information.
- Your child may need to see his caregiver to have his wound checked, or to remove stitches. Your child may need to see a speech therapist if his PEG tube is temporary. A speech therapist may test how well your child swallows. If your child's swallowing improves, and he can eat enough food, your child's PEG tube may be removed.
Feeding your child through his percutaneous endoscopic gastrostomy tube:
Follow your child's caregiver's instructions about how much, and how often, to feed your child. Talk with your child's caregiver if you have questions about feeding your child. For each feeding, do the following:
- Raise your child's head, or have him sit up during each feeding. Your child should keep his head up for at least one hour after his feeding is finished.
- Before each feeding, check for residual (undigested) formula in your child's stomach. Attach a syringe to your child's PEG tube and pull back on the plunger to check for residuals. Checking residuals will also help you know that your child's PEG tube is in his stomach. Ask your child's caregiver how much residual formula there should be in the stomach. Ask your child's caregiver what to do if there is too much residual formula before a feeding.
- Flush your child's PEG tube with a syringe filled with water or other liquid, as directed by your child's caregiver. You will flush your child's PEG tube before and after each feeding. You will also flush your child's PEG tube after checking for residual formula. If your child is on a continuous feeding, flush the PEG tube every four hours. Flushing the PEG tube helps prevent the tube from becoming blocked. Ask your caregiver what size syringe to use, and how much liquid to use for each flush.
- Clean the top of your child's formula container before opening it.
- Give your child his formula at room temperature. Do not hang the feeding bag with more than four hour's worth of formula at a time. This helps prevent feeding your child too much and keeps the formula from spoiling.
- Cover and put unused formula in the refrigerator. Make sure you use any opened formula within 24 hours.
- Clean your child's feeding bag with soap and water between each feeding. Ask your child's caregiver how many times you can use each feeding bag.
Giving your child medicine through his percutaneous endoscopic gastrostomy tube:
Follow your child's caregiver's instructions about how to give your child medicine through his PEG tube.
- Do not mix your child's medicines together. Give each medicine one at a time.
- Do not put pills into your child's PEG tube. Get liquid medicines when possible. Crush and dissolve pills in warm water before putting them in your child's PEG tube. Crush pills in a plastic bag with a rolling pin or a can. Always check with your child's caregiver before crushing any medicines. Some medicines cannot be crushed, and may be harmful to your child. Medicines that cannot be crushed include enteric-coated, sustained release, chewable, and sublingual (under the tongue) medicines.
- Sometimes, capsules may be opened to dissolve the medicine in water. Always talk with your child's caregiver to learn if the medicine capsule is safe to open and dissolve.
- Flush your child's PEG tube between each medicine, and after giving the last medicine.
- Do not give your child his medicines at the same time he is getting a feeding.
Caring for your child's stoma:
Your child's stoma may take about two weeks to heal. Until the area heals, and there is little to no drainage, change the bandage every day. After your child's stoma heals, change the bandage as often as your child's caregiver suggests. You should also change the bandage if it gets soiled. Ask your child's caregiver to show you how to care for the stoma. To clean your child's stoma, do the following:
- Wash your hands with soap and water.
- Remove the bandage from around the PEG tube.
- Check for changes in and around the stoma, such as swelling, redness, or bad-smelling drainage.
- While the area is healing, use a cleaner your child's caregiver suggests. Once the stoma heals, you can use soap and water to clean it. Make sure you rinse all of the soap away. Do not use soap with perfume in it, as perfumes can dry your child's skin.
- Gently pat the area until it is completely dry. If there is an outside bumper attached to the PEG tube, make sure you dry under the bumper.
- Turn your child's PEG tube in a complete circle if there are no stitches holding it in place. Turning the tube helps create a smooth stoma while it heals. Turning the tube also helps prevent tissue from growing over it.
- Place the gauze bandage around the PEG tube and above the outside bumper. Secure the bandage as directed by your child's caregiver. Do not use a bandage that is tight against your child's skin. Air needs to be able to pass under the bandage.
Caring for your child's percutaneous endoscopic gastrostomy tube:
- Change the position of the clamp on your child's PEG tube each day. This will help prevent tube damage from the clamp.
- Check your child's PEG tube for cracks or splits before each use.
- Clean the tip of your child's PEG tube daily with water and a small brush. Ask your child's caregiver what kind of brush to use to clean the tube tip.
- If your child's PEG tube becomes clogged, your child's caregiver may have you put carbonated (bubbly) liquid in it. Never try to unclog your child's PEG tube with any object, such as a wire.
- If your child's PEG tube comes out, clean the area and cover it with a bandage. Call your child's caregiver right away.
- When your child's PEG tube is not in use, loop the tube and tape it to his stomach. Do not bend the PEG tube, as it can put pressure on your child's stoma.
Checking the balloon on your child's percutaneous endoscopic gastrostomy tube:
Your child's PEG tube may have a liquid-filled balloon on one end to hold it inside his stomach. Check the balloon for leaks every 7 to 10 days. Make sure you know the amount of liquid that should be inside the balloon. Pull the liquid out of the balloon with a syringe, and check how much liquid you pulled out. If the balloon has less liquid than it should, put the right amount of liquid back in. Ask your child's caregiver what kind of liquid to use. If the balloon has lost five milliliters (ml) or more of liquid, the balloon may have a leak. Call your child's caregiver to report a leaky balloon.
Decompressing your child's stomach:
Your child's PEG tube may be capped when it is not in use. If your child feels gas pains or has nausea, uncap the PEG tube to decompress the stomach. Uncapping your child's PEG tube may release the gas and resolve his nausea. Ask your child's caregiver when you should cap and uncap your child's PEG tube.
Take your child to the dentist for regular visits:
Even if your child does not take anything by mouth, his mouth and teeth still need cleaning. Make sure your child keeps seeing his dentist regularly.
CONTACT A CAREGIVER IF:
- The skin around your child's PEG tube breaks open, skin grows over his tube, or his stoma gets larger.
- You cannot move your child's PEG tube, the tube comes out, or the tube cracks or breaks.
- Your child has a fever.
- Your child's PEG tube moves in or out of his stoma more than one centimeter.
- Your child's PEG tube is leaking, or liquids will not enter the tube and spill out.
- Your child has nausea, vomiting, diarrhea, or cannot have a bowel movement (BM).
- You have questions or concerns about your child's procedure or care.
SEEK CARE IMMEDIATELY IF:
- The skin around your child's PEG tube is warm, swollen, red, or has pus coming from it.
- Your child has diarrhea leaking out around his tube, or his BMs look like formula.
- Your child has increased stoma drainage, or his stoma is bleeding and will not stop.
- Your child has sudden trouble breathing.
- Your child vomits blood, you see blood in your child's BMs, or his BMs look like black tar.
- Your child's stoma has green, yellow, or bad-smelling drainage coming from it.
- Your child's stoma, or the skin around it, is bright red, swollen, and has blisters.
- Your child's stomach becomes tight, hard, sore, or swollen.
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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.