A Percutaneous Endoscopic Gastrostomy (PEG) tube is a soft, flexible feeding tube that provides a pathway for nutrition, hydration, and medication directly into the stomach. The term “percutaneous” means through the skin, “endoscopic” refers to the placement method, and “gastrostomy” means creating an opening into the stomach. This device is utilized when an individual is unable to safely consume adequate nourishment by mouth to meet their body’s needs. The PEG tube maintains nutrition by bypassing the mouth and esophagus, which is necessary for long-term feeding, generally considered more than four weeks.
Core Function and Indications
The primary role of a PEG tube is to support nutritional status and hydration when the normal process of swallowing is compromised. It serves as a secure route for enteral feeding, which delivers specialized liquid formula directly into a functioning gastrointestinal tract. Enteral feeding is preferred over intravenous nutrition because it carries a lower risk of infection, preserves the gut lining, and is generally more cost-effective.
A PEG tube is often indicated for patients experiencing difficulty swallowing, a condition known as dysphagia, which prevents safe or sufficient oral intake. This can result from neurological disorders, such as a stroke, Parkinson’s disease, or advanced dementia, where muscle control is impaired. Individuals with head and neck cancers may also require a PEG tube due to obstruction or as a temporary measure during radiation and chemotherapy treatments.
Unlike a nasogastric (NG) tube, which is inserted through the nose and is typically used for short-term feeding, the PEG tube is intended for long-term use. It allows for direct access to the stomach without the irritation and potential complications associated with a tube passing through the nasal passages and throat. It can also be used for decompression, which involves removing excess air or fluid from the stomach.
The Placement Procedure
The placement of a PEG tube typically takes 20 to 30 minutes and is performed under sedation or light anesthesia. The process relies on an endoscope, a thin, flexible tube with a camera and light, which is passed through the mouth, down the esophagus, and into the stomach. This allows the physician to visualize the inside of the stomach and determine the safest site on the abdominal wall for the tube exit.
Once the optimal location is confirmed, the area of the abdomen is numbed with a local anesthetic, and a small incision is made. A needle is then inserted through the abdominal wall and into the stomach, guided by the light of the endoscope. A wire is passed through this needle and grasped by the endoscope, which is then pulled back out through the mouth.
The PEG tube is then attached to this wire and pulled down through the mouth, esophagus, and stomach, finally exiting through the incision in the abdomen. An internal bumper or retention disc sits against the stomach wall to hold the tube in place, while an external fixation device is secured on the skin. Patients are monitored afterward, and feedings may begin within a few hours, though a brief hospital stay is often required for recovery.
Essential Daily Care
Routine care of the PEG tube site is necessary to prevent infection and ensure proper function, focusing on cleaning the stoma and maintaining tube patency. The skin around the tube should be cleaned daily with mild soap and water to remove any drainage or crusting. It is important to dry the area thoroughly after cleaning to prevent skin breakdown and irritation.
A crucial part of daily care is the rotation and advancement of the tube to prevent the internal bumper from becoming embedded in the stomach lining, a condition called buried bumper syndrome. After the initial healing period, the external fixation device should be released, and the tube gently pushed a few centimeters inward and rotated 360 degrees before being pulled back until slight resistance is felt. The external disc is then repositioned a small distance, typically 2 to 5 millimeters, away from the skin.
Flushing the PEG tube with water is performed multiple times a day to prevent blockages, especially before and after administering formula or medications. A typical flush volume is around 30 milliliters of water, using a syringe to gently push the fluid through. For administering medications, pills should be crushed finely, mixed with water, given separately, and followed by a water flush.
Recognizing and Managing Issues
While the PEG tube is a reliable device, users must be vigilant for common issues that require troubleshooting or medical intervention. Signs of infection at the stoma site include increased redness, swelling, warmth, and thick, foul-smelling discharge or pus. Minor leakage of gastric contents around the tube is common initially, but persistent or increasing leakage can lead to skin irritation and may indicate that the external fixation device is too loose or the tube size is incorrect.
Tube clogging is a frequent mechanical problem, often caused by inadequate flushing or the improper administration of medications. If a blockage occurs, the tube can often be cleared by gently pushing and pulling a syringe filled with warm water in a small, rapid motion. If this maneuver is unsuccessful, the feeding should be stopped immediately, and a healthcare professional should be contacted.
Accidental dislodgement of the tube is a serious concern, as the stoma tract can begin to close rapidly. If the tube falls out, it is important to cover the site with a clean dressing and seek medical attention immediately for reinsertion. Persistent problems, such as a tube that cannot be rotated or advanced, difficulty flushing, or significant abdominal pain, should also prompt a call to a doctor to rule out complications like the buried bumper syndrome.