Percutaneous Endoscopic Gastrostomy (PEG) Insertion
This leaflet has been written by staff working in the Endoscopy Unit at Chelsea and Westminster Hospital.
We hope you find it useful. If, after you have read it, you have any questions or concerns, please ring us on our direct line 020 3315 3056/5223.
When you come into the Unit (2nd Floor, Lift Bank B), please talk to us about any worries and ask any questions you have.
If you would like to change your appointment time or date, please contact the Endoscopy Unit booking team on 020 3315 4141/5984 or email us Chelwest.cwdiagnosticcentre.admin@nhs.net.
Your appointment time in Endoscopy is approximate because some procedures may take longer than expected and emergency procedures need to take priority. Please expect to be in the department for several hours – having pre-procedure checks, the procedure and for recovery after the procedure.
What is a PEG?
PEG is short for ‘Percutaneous Endoscopic Gastrostomy’ tube. It is a thin, flexible tube that passes through the skin of the abdomen and into the stomach. It allows liquid food, drinks and medication to be fed directly into the stomach.
Why do I need one?
You may need a gastrostomy tube because you are unable to drink or eat enough (or even at all) and it is therefore not possible to meet your nutritional needs without one. Sometimes a gastrostomy tube is placed in advance because a particular treatment is known to cause problems with eating or drinking, or the staff treating you predict that you will be unlikely to eat or drink enough due to your illness.
If you decide that you do not wish to have a tube, it may mean you are unable to maintain your nutrition and you will lose weight. It may also affect your ability to cope with your medical treatment. However, it is your choice and we will support you in the best way we can, even if you decide that you do not want a tube.
Will a gastrostomy tube stop me from eating and drinking?
No. Provided you have been told that you can eat and drink, having the tube will make no difference.
Will it hurt?
Most people do not remember the tube being put in because they have been given sedation. Once the sedation and local anaesthetic have worn off, you can expect to have some discomfort around the PEG insertion site. Your doctor can prescribe some pain relievers for you, which we recommend you take if you do have pain. The discomfort can last for a few days and you will be given some to take home if necessary. If the pain is very severe or does not go away, please inform a member of staff.
Will I have to stay in hospital?
Yes, you will need to be admitted to a ward after the procedure. You will need to be in hospital for typically two nights. On the ward, you will see a doctor who will examine you and explain the procedure. You may be asked to sign a consent form on the ward although usually, a consent form is signed in the Endoscopy Unit on the day of your procedure, where it will be done.
A nurse will explain what you should expect and how the ward routine works. You will also have some blood tests.
On the day of the PEG insertion
You should not eat or drink anything for 6 hours prior to the procedure. In the morning, a cannula (small needle) will be inserted in the back of your hand and antibiotics will be given to you on the ward. You will then be taken to the Endoscopy Unit.
What are the benefits and risks?
The benefit is that this procedure will help your nutrition intake and medication administration.
Gastroscopy - There is an extremely small risk of bleeding or a tear in the lining of the gut (about 1 in 2,500), which may require urgent treatment, blood transfusion or an operation. Gastroscopies also involve a slight risk of damage to crowned teeth or dental bridgework.
PEG Insertion - One in 150 chance of death, one in 30 serious complications (making a hole or bleeding) and 1 in 8 less serious complications. There is a small chance of an infection at the site on the skin that the tube is placed and this can lead to the tube being removed. Rare complications include chest infection and a slight risk to teeth or dental bridgework. Sedation causes breathing problems in about 1 in 100 cases although these are usually mild. Surgery and/or blood transfusion are very rarely required following procedure.
What will happen when I come in?
On admission to the unit a nurse will ask you several questions about your health, current medication (please bring an up to date list with you), take your blood pressure and pulse, and ask you to get changed into a gown.
Please leave any valuables at home or in your ward (inpatients), as we cannot be responsible for any valuables lost whilst you are in the unit.
Prior to the test you will be seen by the endoscopist. This is an opportunity to discuss the test before you or your relative sign a consent form. Please ask any questions you may have. It is important that you understand what is going to happen.
What will happen during the procedure?
In the procedure room you will lie on a trolley (narrow bed) or ward bed, on your back. Two nurses and the endoscopist will stay with you throughout the test. You will be asked to bite on a small plastic mouthpiece to help keep your mouth open. This will also help to protect your teeth during the test. Dentures have to be removed if they are loose.
During the test you will be given oxygen through little prongs that fit just inside your nostrils. Your blood pressure, pulse and oxygen levels will also be monitored. When the endoscope is passed through your mouth it is likely to be uncomfortable. It may make you feel sick or you may retch. The endoscope will not interfere with your breathing.
You will be given a local anaesthetic to numb the area on your stomach where the tube will be inserted. An endoscope (a flexible tube with a light and a camera at one end) will then be passed through your mouth, into the back of your throat and down into your stomach. A small cut is made in the skin on your abdomen and the PEG tube will be passed through. Finally, a dressing will be placed over the site. The whole procedure usually takes around 15 – 20 minutes from start to finish.
What will happen after the procedure?
When it is safe for you to transfer to the ward, the endoscopy nurse will arrange for your ward nurse and a porter to transfer you. It is usually necessary to wait a few hours before you can use the tube. Full instructions will be given by the endoscopy nurse to your ward nurse on when feeding can be started.
How will I know I am looking after it properly?
Before you go home from the ward, the nurse will check that you know how to look after your gastrostomy. After discharge, the gastrostomy site will be checked regularly by your district nurse at home. If at any point you are worried about it, please contact your district nurse or your GP.
How long will I need it?
The tube will be removed when you are eating and drinking enough and you no longer need to use it to provide extra nutrition.
In some cases you may need the tube permanently, but your medical team will have discussed this with you. This does not prevent you from deciding that you want the tube to be removed anyway.
FAQs
Q: What should I look out for?
A: The tube can sometimes become blocked. If this happens, flushing the tube with fizzy or lukewarm water can help dissolve the blockage.
The insertion site can become infected. If the skin around the tube becomes red, or if it leaks yellow fluid, you should contact the hospital as soon as you may need antibiotics.
If the place where the PEG goes into your body is painful, it might mean that the fixation device is too tight or there is an infection. Please contact the Endoscopy Unit from 8am–6pm on 020 3315 3056/5223
Outside of these times please go to your nearest Accident and Emergency and remember to take your Endoscopy report with you.
Q: Can I have a bath or a shower?
A: You can shower from the day after the tube has been placed. Baths must be shallow. Avoid soaking the site for at least two weeks until it has healed.
Q:Can I go swimming?
A: Yes, once the site fully healed.
Q:Will I be able to wear normal clothes?
A:The tube can be covered with normal or loose clothing, but will show under tight clothing. You may find it more comfortable to wear your waistband below your gastrostomy tube.
Q: Discharge information
A: You will be discharged from the ward with seven day supply of the following
1. 50ml syringe (for flushing your PEG tube)
2. Pain relieving medications
3. Saline syringes (for cleaning the site around the PEG tube)
4. Gauze (for cleaning the site around the PEG tube)