PEG Tube Placement

What is a percutaneous endoscopic gastrostomy (PEG) tube?

A percutaneous endoscopic gastrostomy (PEG) tube is a feeding tube surgically placed through your abdomen into your stomach. It’s placed using a lighted flexible scope called an endoscope. The endoscope lets your healthcare provider see inside your stomach as the procedure is done.

The PEG tube can stay in your stomach for months or years so you can take fluids, medicines, and nutrition through it when you can’t take in enough by mouth. Once you have this type of tube, it is important to let your healthcare provider know if the tube comes out because the opening will close quickly.

Why might I need a PEG tube?

A PEG tube may be a good choice for children or adults who can’t eat and drink enough to meet their daily nutrition needs. A PEG tube may also help prevent a dangerous condition called aspiration. But a PEG tube can't fully eliminate aspiration. Aspiration can happen if you have trouble swallowing normally and food or liquids enter your lungs.

Some common conditions in which a PEG tube may be recommended include:

• Birth defects

• Problems swallowing

• Stroke

• Cancer of the mouth or esophagus

• Diseases of the esophagus

A PEG tube may be placed if you have a long-term condition that will not allow you to swallow. To have this procedure, you must be able to digest food normally once it reaches your stomach.

In some cases, a PEG tube may be temporary. For example, if you have a minor stroke from which you may recover. A PEG tube lasts about 1 year. Replacing the old tube is usually a simple procedure that your healthcare provider can do without surgery or anesthesia.

What are the risks of PEG tube placement?

PEG tube placement is a safe procedure, but all surgeries carry some risks. You will need to sign a consent form that explains the risks and benefits of the surgery and gives your healthcare provider permission to do the procedure. You should discuss these risks and benefits with your healthcare provider. Some potential risks of PEG tube insertion include:

• Reactions to the anesthesia

• Pain

• Leakage of stomach contents around the tube

• Infection of the tube site

• Infection that spreads inside the belly

• Aspiration

• Bleeding from the incision area

• Bleeding or infection from damage to other organs inside the belly

• Blockage or dislodging of the tube

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for a PEG tube placement?

Ask your healthcare provider to tell you what you should do before PEG tube placement. Below is a list of common steps that you may be asked to do:

• In the days before your surgery, tell your healthcare provider about any prescription and over-the-counter medicines, vitamins or herbal supplements you take.

• You may be asked to stop taking aspirin or other medicines that thin your blood and may increase the chance of bleeding. 

• You will be asked to sign a consent form before the procedure. Read the form carefully and ask any questions you have before you sign it.

• Tell your healthcare provider if you or someone in your family has any history of reaction to anesthesia.

• If you smoke, you may be asked to stop smoking well before surgery.

• Follow any directions you are given for not eating or drinking before surgery.

• Ask your healthcare provider if you should take your regular medicines with a small sip of water.

• Wear loose, comfortable clothing on the day of surgery.

• If you are going home after surgery, arrange to have someone drive you home and stay with you during the early recovery period.

What happens during a PEG tube placement?

Talk with your healthcare provider about what will happen during PEG tube placement. PEG tube placement is usually done under local anesthesia and sedation.

You will have an IV (intravenous) line started in your hand or arm so you can receive fluids and medicines. You may be given medicine for pain and to make you sleepy through your IV. You may also be given antibiotics through your IV.

Before the procedure starts, you will need to remove any dentures. A numbing medicine may be sprayed into your throat to prevent gagging from the endoscope. A mouth guard may also be inserted. The actual procedure takes about 20 minutes. This is what usually happens during the procedure:

1. The skin over your belly is cleaned and a numbing medicine is injected.

2. The endoscope is passed through your mouth into your stomach.

3. A small surgical cut is made through your skin and into your stomach.

4. The PEG tube is inserted through the opening while the healthcare provider watches through the endoscope.

5. The tube is held in place inside your stomach with the help of a special balloon or a cap.

6. A small dressing is placed at the new opening.

What happens after a PEG tube placement?

You will be taken to the post-anesthesia care unit to be observed while you recover from the anesthesia. You may be able to go home on the day of the procedure. Here is some of what you can expect after the procedure:

• Expect to feel some pain, such as pain at the incision and cramping or gas pain. Follow your healthcare provider's instructions for pain control.

• The dressing over the incision area can be removed after about 1 or 2 days as instructed.

• The incision area takes about 5 days to heal. You will be taught to clean the area daily with soap and water. After cleaning, dry the area using a small gauze pad to cover it. Don't let the gauze or the tube bumper become too tight against your belly. They should be loose.

• Ask your healthcare provider when you can start showering and bathing.

• You should be able to gradually return to normal activities, depending on your overall condition. Ask your healthcare provider about any activity restrictions.

• Use of the PEG tube for feeding begins gradually with clear fluids and progresses to special formula feedings.

There is a lot to learn about using and caring for a PEG tube. You will need to work closely with your medical team. The team may include healthcare providers, pharmacists, and nutrition specialists. You will probably be told to make sure you are always upright when feeding. You may still be able to eat by mouth. Talk this over with your healthcare team.

Here are some of the other steps you need to learn:

• How to care for the skin around the tube

• What symptoms to look for that could mean an infection

• How to empty your stomach

• What to do if the tube gets blocked

• What formula to use and how to feed yourself

Tell your healthcare provider right away about any of the following:

• Increasing pain or pain that is not relieved by medicine

• Any drainage, bleeding, redness, or swelling around the tube

• Fever

• Vomiting, cramping, nausea, or diarrhea

• Aspiration

• The tube comes out or becomes blocked

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure