Percutaneous Endoscopic Gastrostomy (PEG) feeding provides nutrition, fluids, and medications directly into the stomach. It is used when an individual cannot eat or drink enough by mouth. A PEG tube, often referred to as a G-tube, is a flexible tube inserted through the abdominal wall, creating a direct pathway to the stomach.
Reasons for PEG Tube Placement
Common reasons for placement include dysphagia, or difficulty swallowing, which can arise from neurological conditions. These include strokes, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), and certain brain injuries. Head and neck cancers, or surgeries in those areas, can also impair swallowing or overall oral intake, making a PEG tube a supportive measure. Additionally, a PEG tube may be considered for severe malnutrition or conditions that require long-term nutritional support, extending beyond typical short-term feeding methods.
The PEG Tube and Its Placement
A PEG tube, a thin, flexible tube extending from the abdominal wall directly into the stomach, is placed through a minimally invasive procedure using an endoscope, a long, flexible tube with a camera. During the procedure, typically under sedation and local anesthesia, the endoscope is guided through the mouth, down the esophagus, and into the stomach. A small incision is then made in the upper abdomen, and with endoscopic guidance, the PEG tube is carefully inserted through this opening. An internal bumper or balloon helps secure the tube inside the stomach, while an external disc or cap keeps it in place on the outside of the body. The entire process usually takes about 20 to 30 minutes, and many individuals can return home the same day.
Administering Nutrition and Medications
Once a PEG tube is in place, it delivers liquid formulas, water, and medications into the stomach. Nutritional formulas provide a balanced intake of proteins, carbohydrates, vitamins, and minerals. These can be administered in two main ways: bolus feeding or continuous feeding.
Bolus feeding involves giving larger amounts of formula several times a day using a syringe, similar to meal times. Continuous feeding uses a pump to deliver formula slowly over an extended period, often throughout the night, which can reduce the risk of discomfort and aspiration. Medications, preferably in liquid form, can also be given through the tube. Solid medications, if approved by a healthcare provider, can be crushed and mixed with water before administration. The tube must be flushed with water before and after each administration to prevent blockages.
Daily Care and Potential Concerns
Daily care of the PEG tube site prevents complications. This includes cleaning the skin around the tube with soap and water daily, ensuring the area remains dry, and checking for any signs of irritation or infection. The tube should be secured to prevent accidental pulling or dislodgement, which can cause the opening to close quickly. Regular rotation of the tube, if recommended, can help prevent it from sticking to the skin. While PEG tubes are generally well-tolerated, some issues can arise.
Skin irritation or redness around the insertion site is common but often resolves with proper hygiene. Tube blockages can occur, often due to medication residue or inadequate flushing, and may require specific techniques for clearing. Accidental dislodgement requires prompt medical attention to prevent the opening from closing.
When a PEG Tube is No Longer Needed
A PEG tube is not always a permanent solution; it can be removed if the individual’s underlying condition improves and they can safely resume adequate oral intake. The removal process is generally straightforward. For some tubes, it involves an endoscopic procedure where the internal part of the tube is removed through the mouth. Another method, known as the “cut and push” method, involves cutting the tube near the skin and allowing the internal part to pass naturally through the digestive system. After removal, the small opening in the abdomen usually heals within a short period, often within 24 to 48 hours.