Percutaneous Endoscopic Gastrostomy (PEG) Tubes

Before the Procedure

Before your child’s feeding tube placement, you’ll be shown an actual gastrostomy tube or a picture, along with specific information about how the tube will be placed. Your child may be in the hospital for a few days after the procedure. You’ll be told what to expect regarding a timeline when the procedure is scheduled.

Bathe your child the night or morning before the procedure. Your child shouldn’t be allowed to 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 before the day of the procedure.

Your care team will talk to you about the tube and how it works, along with how to care for it. This information should be given to you again after the procedure.

During the Procedure

Expect the procedure to take one to three hours. Your child will receive anesthesia for the procedure and will then be in the post-anesthesia recovery area for a few hours.

After the Procedure

The care team will watch your child closely after the procedure, from anywhere from a few hours to 24 hours. Pedialyte will be given down the tube and, if tolerated, feedings will be started after that.

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 it. You will need to clean underneath it with soap and water. Sometimes using a syringe labeled “soap” can be used to gently pulse warm, soapy water under the disc (2 to 3 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, which may not comfortable for your child. Try looping the tubing in a gentle arch and 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. You will need to make sure your child doesn’t touch or pull on the tube.

Your child will be given some pain medication post-op, along with a prescription to take at home as needed for comfort. Any medication given needs to be flushed down the tube to make sure it gets to the stomach. Be sure to flush the tube before and after giving medication to prevent the tube from clogging.

It’s important to remember about oral care even if your child doesn’t take any food or medication by mouth. Regular tooth brushing or using an infant swab is helpful.

Your care team will provide you with instructions on what do when you get home. These details will include how to use all your feeding supplies, as well as what you’ll need and where to get more supplies. They may discuss the timeline for next appointments or go ahead schedule your follow-up appointments to see your child’s progress and discuss future tube options, such as moving to a low-profile button.

Your First Day at Home

You’ll want to find a good place to store supplies once you get home. Set up your supplies, including a pump if you continuous feed.

When bathing, don’t have the bath water above the level of the stoma until you’re told it is safe to do that.

Clean the site every day with soap and water using a soft, lint-free cloth or cotton swab, and be sure to clean under the bolster as well.  Be sure to keep the tube and stoma site clean and dry at all times. Expect some drainage to occur in the first few days, but also be on the lookout for major skin or stoma changes that your care team has described before you were discharged.

If the tube feels too tight, contact your care team. They may advise you to loosen the bolster, as weight gain occurs.  As part of your daily tube and stoma care, you’ll need to rotate the tube daily.  You’ll also 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.  Be sure to understand what issues may require urgent (attention within 24 hours) or emergent (immediate) care.  When in doubt-call your care team.

Remember: the first day at home after any big change is going to require some adjustment. But before long, you and your child will become more used to the feeding tube and you’ll develop a new routine that’s second nature to you.

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