Percutaneous Endoscopic Gastrostomy Insertion In Children

WHAT YOU SHOULD KNOW:

Percutaneous Endoscopic Gastrostomy Insertion In Children (Inpatient Care) Care Guide

  • 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.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

  • The anesthesia medicine may cause your child's blood pressure to drop too low. During your child's procedure, the endoscope may damage his esophagus, stomach, or nearby organs and tissues. Damage to your child's organs or tissues may cause bleeding in, and behind, his abdomen. If your child has cancer of the esophagus, the endoscope may spread cancer cells to the PEG tube site. During or after the procedure, liquid from your child's stomach may enter his lungs, causing a lung infection. Air or gas may collect in your child's abdomen. After your child's procedure, he may have bruising around his stoma, and his stoma may be painful. The skin around your child's PEG tube may break open or blister, and tissue may grow over his tube.

  • Your child's PEG tube may become buried in his skin or move out of place. Formula used for feeding may leak out of your child's stoma. Your child's PEG tube may become blocked, and it may crack, break, or leak. Your child may have diarrhea (loose bowel movements), vomiting, fever, and his bowels may stop working. Your child may get GER or an ulcer (hole in the stomach lining). A fistula (abnormal tissue opening) may form between your child's skin and his stomach or bowel. Your child's wound, abdomen, or nearby tissues may become infected, or he may get a life-threatening blood infection.

  • If your child does not get a PEG tube for decompression, his stomach may not empty properly. Liquids from your child's stomach may enter his lungs and cause a lung infection. If your child does not have a feeding PEG tube placed, he may not get enough food for his needs. Not eating can lead to dehydration. Your child could lose too much weight, and he could die.

WHILE YOU ARE HERE:

Before your child's procedure:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that your child 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 child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

  • An IV is a small tube placed in your child's vein that is used to give him medicine or liquids.

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

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

  • Preoperative care: Your child is taken to the procedure room and moved to a table or bed. Your child lies on his back or left side, with the head of the bed raised up.

  • Sedation: Sedative medicine given in your child's IV helps him relax or makes him drowsy.

  • Anesthesia medicine:

    • General anesthesia: General anesthesia puts your child to sleep and keeps him comfortable during the procedure. It may be given in an IV or as a gas through a mask over the face. This medicine may also go through a tube placed in your child's mouth and throat. A mouth tube is called an endotracheal tube, or ET tube.

    • Local anesthesia: Local anesthesia is numbing medicine that keeps your child comfortable during the procedure. Local anesthesia may be sprayed into your child's throat, so he will not feel pain while the endoscope is placed. A shot of local anesthesia may be given in your child's abdomen to numb the procedure area. Local anesthesia may be used with, or without, general anesthesia. If only local anesthesia is used, your child is awake during the procedure. Your child may still feel pressure or pushing, but he should not have pain.

During your child's procedure:

  • An endoscope is placed in your child's mouth and moved down his throat and esophagus into his stomach. Your child's stomach is suctioned to remove any fluid. Your child's stomach may be filled with air to help the caregiver better see inside your child's stomach. The light on the end of the endoscope may show through your child's abdomen. The light helps your child's caregiver find the best place on the abdomen to insert the PEG tube. A small cut is made in your child's abdomen. A needle with a catheter (tube) over it is put through the skin and into your child's 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 child's mouth. Your child's caregiver attaches the PEG tube to the wire. The PEG tube is pulled back through the endoscope, and into your child's stomach. Inside your child's stomach, one end of the tube is held in place with a bumper (attached plastic). The other end of the PEG tube is pulled out through the cut in your child's abdomen. The opening in your child's abdomen where the PEG tube comes out is called a stoma. The endoscope and wire are removed, and the tube is secured on your child's abdomen with another bumper. Your child's caregiver may insert the endoscope again to check the placement of the PEG tube.

  • An endoscope may not be used if there is a blockage or cancer in your child's throat or esophagus. Your child's caregiver may place the PEG tube into the stomach through a cut in the abdomen. This may also be done if the endoscope light cannot be seen to choose the best PEG tube site. Your child's caregiver uses an ultrasound to guide the procedure. An ultrasound uses sound waves to show pictures of the inside of the body on a screen. The tube is held in place with a small inflated (blown up) balloon inside of your child's stomach.

After your child's procedure:

  • Your child is taken to a room to rest until he is fully awake. Caregivers will watch him for any problems. Your child must not get out of bed until caregivers say it is okay. When caregivers see that your child is not having any problems, he may be taken back to his room.

  • Your child may get his first PEG tube feeding four hours after it is put in. Your child's wound (procedure area) bandage may be changed the first day after the PEG tube is placed. Before leaving the hospital, caregivers will teach you how to use your child's PEG tube. You and your child may also see a nutrition caregiver to talk about 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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