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Percutaneous Gastrostomy Tube (PEG)

What is Percutaneous Gastrostomy Tube (PEG)?

A Percutaneous Gastrostomy Tube (PEG) involves the placement of a tube through the abdominal wall and into the stomach through which nutritional liquids can be infused. It is a procedure that allows nutritional support for patients who cannot take food orally and is performed at an Endoscopy Centre under moderate sedation.
 

How to Feed Through PEG

Your doctor/nurse will educate you on the use of the PEG. Please follow the instructions below after you are discharged from the Endoscopy Centre:

  • Before feeding, aspirate to check residual volume of feed using a syringe.
  • If the volume of feed is more than 150mls, delay feeding for 2 hours so as to allow more time to empty the previous feed from the stomach.
  • Ensure that the patient is in a semi-upright (30 degrees) position during feeding and 60 minutes after feeding to reduce the risk of reflux (backflow) and aspiration.
  • Feed according to the feeding formula schedule provided.
  • Pour the feed/medication into the syringe and allow the fluid to flow into the stomach/jejunum slowly.
  • Keep the syringe at about 6 inches above the insertion site level to feed at the appropriate speed.
  • Do not mix medication and feed in the same container.
  • Check for nausea, vomiting, abdominal discomfort and bloating during and after feeding.
  • Stop feeding at least 30 minutes before any scheduled chest physiotherapy session.
  • Frequent mouthwash of at least once every 4 hours is necessary. This minimizes the risk of mouth infections.

     

Care of the PEG Tube

Flushing of the Tube

The PEG pump comes with various safety features, including:

  • Run at least 25 mls of water through the tube to check for patency.
  • Flush the tube with at least 25 mls of warm water at the end of feeding.

To prevent blockage of the tube, it is very important that the tube is flushed with plain water before/after feeding or giving medication.


Blocked Tube

If the PEG is blocked, you are advised to try and unclog the blockage immediately by following the instructions below:

  • Use a 20ml syringe and flush the tube with some pressure to dislodge the blockage.
  • Fizzy fluid such as cola is preferred as it contains carbon dioxide which will help to break down the food residue. Pineapple juice is also recommended as it contains an enzyme which can help to dissolve the food deposit.
  • Gently rock the syringe back and forth to dislodge the blockage.
     

Please contact your doctor or seek medical assistance at our 24 HR Emergency Clinic if you are unable to clear the blockage in the tube.


Dislodged Tube

A dislodged PEG tube must be attended to immediately as the stoma will seal off quickly if a new tube is not inserted. Please contact your primary doctor or visit our 24 HR Emergency Clinic so that arrangements can be made to insert the tube as soon as possible.


Care of the Stoma Site

The area around the tube should be cleansed daily with water and kept dry at all times. Please follow the instructions below after your PEG procedure:

  • Gauze dressing is not required after 10 days if the stoma is clean and dry.
  • Rotate the tube in a clockwise direction (360 degrees) every week to prevent adherence to the sides of the stoma.
  • Anchor and secure feeding tube with micropore tape to the abdomen when not in use.
     

What are the likely complications of PEG?

PEG may result in medical complications. Please contact your doctor if the area around the tube display the following signs and symptoms:

  • Clogging of the tube
  • Discharging pus
  • Leakage of nutritional fluids
  • Pain
  • Redness
  • Swelling
     


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