Percutaneous Endoscopic Gastrostomy (PEG) Tubes
Before the Procedure
Bathe the night or morning before the procedure. Don’t eat or drink anything for several hours before the procedure is scheduled. You’ll be told a specific number of hours to hold fluids and food the day before the procedure.
Your care team will talk about the tube and how it works, along with how to care for it. This information will be given to you again after the procedure.
During the Procedure
After the Procedure
The tube has a disc (bolster) on the outside to make sure it stays in place. This needs to be turned daily to make sure the skin doesn’t stick to the tube. You will need to clean underneath it with soap and water. Sometimes a syringe labeled “soap” can be used to gently pulse warm, soapy water under the disc (5 ml at first). Then use another syringe labeled “water” to pulse rinse with warm water. This will gently remove any residue post-op and in the days to come. Be sure to thoroughly dry the area afterwards.
Expect to see some drainage (clear, cream, or blood-tinged) at the site. Your care team may use a small dressing under the bolster to absorb the drainage. Dressings will be used only in the initial days of post op, if needed. Be sure to change the dressing as often as needed to keep the site dry, as wet and soiled dressings can cause the skin to breakdown around the stoma site. Some redness after the procedure is normal and should go away in about three days.
The gastrostomy tubing may pull to one side, and this may feel uncomfortable. Try looping the tubing in a gentle arch and then tape it to the abdomen. Sometimes a small roll of gauze near the stoma site can be used to rest the looped tubing on and then it can be taped in place. Try to not touch the tube very much to help prevent it from being pulled out.
Some pain medication will be given post-op, along with a prescription to take at home. Any medication given needs to be flushed down the tube to make sure it gets to the stomach. Be sure to flush the tubing before and after taking medication to prevent clogs.
Remember that oral care is still very important, even if food or medication is not taken orally. Frequent tooth brushing and rinsing your mouth several times a day is a good idea.
Before you leave the hospital, your care team will review instructions with you, including what supplies you’ll need or where you can get them, as well as how to your feeding supplies and when to call. Ask as many questions as you need to feel comfortable before leaving. They may schedule follow up appointments with you or discuss future tube options as low-profile tubes can replace PEG tubes 8-12 weeks after your procedures, based on how well your stoma heals.
Your First Day at Home
When bathing, don’t fill the bath water above the level of the stoma until you’re told it’s safe to do that. Showering is also usually acceptable the day after the surgery.
Clean the site every day with soap and water, using a soft cloth or cotton applicator, and be sure to clean under the bolster as well. Expect some drainage to occur in the first few days, but also be on the lookout for major skin or stoma changes, as described by your care team. Wearing loose fitting clothes are recommended for added comfort.
If the retention disc feels too tight, talk with your doctor, as it can be loosened as weight gain occurs. You’ll need to rotate the tube daily.
If you use a feeding pump and bag, loop the extra tubing gently and tape the loop to prevent any accidental pulling on the stoma.
You’ll want to refer to your written directions for feeding instructions. This includes when to feed, what to feed, how much to feed, and pump-setting information if relevant.
Understand what requires urgent (within 24 hours) or emergent (immediate) care and never be afraid to call your care team with questions.
Remember: the first day at home after any big change is going to require some adjustment. But before long, you’ll become more used to the feeding tube and you’ll develop a new routine that’s second nature to you.