Having a percutaneous endoscopic gastrostomy (PEG)

Patient information service

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Please note that your appointment time is to see the nurse before your procedure, after which you could still be waiting for up to three hours for the procedure itself.

Due to limited space, please bring only one person (an adult) to accompany you. This person will be asked to leave straight after the initial admission, and will be advised when to return. If you have any concerns or queries, please discuss this with a nurse on the day of your PEG.

Please bring your dressing gown and slippers with you so that you will be comfortable while you remain in the waiting area, which is divided into separate male and female waiting areas.

Lockers are available for you to store your personal belongings.

You must remove dentures, contact lenses and glasses in the procedure room.

Red flag symptoms: (causes for concern)

1. Pain on feeding/flushing PEG or prolonged or severe pain.

2. External leakage of gastric contents.

3. Fresh bleeding.

If you develop one or more of the above red flag symptoms within 72 hours of PEG placement seek urgent medical attention from your GP or A&E.

Red flags are serious issues that could indicate that there has been a complication.

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IMPORTANT

Please read all of this booklet now, as you will need to make some preparations before you have the test.

If you are diabetic, please ring 0117 342 7981 as soon as possible, as your appointment may need to be changed

and you may need further written information.

If you are pregnant, breastfeeding, are on any blood-thinning medication or have a history of bleeding

disorders or take any medication you have been told is essential (e.g. medication for Parkinson’s) please ring

0117 342 7981 before coming for your test, and before taking any medication which has been sent to you. This line is open between 9.00am and 5.00pm, Monday to

Friday. Outside of these hours, you can leave a message on the answer machine. Please be aware that this phone

line is not manned continuously during unit opening hours, but we will endeavour to respond to your voice

message as soon as possible.

If you are unable to attend please inform us immediately on 0117 342 1336. The booking office is open from

Monday to Friday 9.00am to 5.00pm.

We are a mixed sex unit, with separate male and female changing rooms and recovery areas

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What should I expect?

You have been advised by your doctor to have a Percutaneous Endoscopic Gastrostomy (PEG) tube. A PEG tube is a small feeding tube which is inserted directly into the stomach. It will provide you with a safe long term method to receive nutrition, fluid and medication.

The procedure is done in the Endoscopy unit performed with sedation and local anaesthetic. It is carried out using a small, flexible camera (called a gastroscope) used to examine the inside of your stomach.

The feeding tube will then be passed through a very small opening through the skin and between the navel and the breastbone into your stomach.

Risks and complications

Although the procedure is relatively safe and major complications are rare, there are risks involved in PEG placement. Should any major complications occur it may be necessary to consider an operation. There is a major complication rate of about 3% (i.e. 3 out of every 100 patients may experience these). These include:

• Aspiration.

• Tube dislodgement.

• Leakage.

• Breathing problems either during or after the procedure.

• Perforation of the bowel.

• Inflammation/infection in the abdomen.

• Rare complications include perforation of the bowel and peritonitis. These complications require urgent medical treatment.

Minor complications occur in approximately 20% (20 out of 100) of cases. These are mostly related to infection around the site of the tube and leakage from the site of the tube.

These problems can usually be easily treated. It is important that you are aware of and understand the risks before you agree to have a PEG tube inserted. A member of the medical team will discuss this with you.

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Preparation

To allow a clear view, the stomach must be empty. Therefore you must not have anything to eat or drink for at least six hours before the procedure.

If you are being fed through a tube through your nose, you must not have any fluids passed down this for at least six hours before the procedure.

A blood test will be arranged prior to your procedure to check the clotting level of your blood.

You will need to have a single dose of antibiotic just before the PEG is placed.

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A nurse will go through admission questions with you, or ask you to fill out a form. If you have any worries or questions, don’t be afraid to ask. The staff will want you to be as relaxed as possible for the test and will not mind answering your queries. If you are having a day case PEG a nutrition nurse will review you either before your PEG is placed, or on the morning of your PEG and complete some teaching with you. If you haven’t already been seen by a dietitian, they will also review you to compete a nutritional assessment and provide you with a feeding regime.

You will need to change and wear a hospital gown for this procedure. You will be seen by the endoscopist (the person who is doing your procedure). Having read this leaflet, please ask for any further explanations before you sign your consent form.

If you need reading glasses, please bring them with you so that you can read any paperwork (including the consent form).

The health care professional carrying out the procedure will ask you to sign a consent form and make sure that you understand the procedure and its implications. Please tell the doctor or nurse if you have had any allergies or reactions to drugs, or previous tests or operations.

During the insertion of PEG

You will be asked to remove any dentures, spectacles or contact lenses if you wear them.

You will be asked to lie on the bed on your back but slightly over onto your left hand side, supported by pillows.

A nurse will stay with you throughout the procedure. The nurse will place a clip on your finger; this is attached to a machine

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which measures your pulse and oxygen level. You will also be given extra oxygen through a sponge placed in your nose. You will be asked to bite gently onto a mouth guard, which will protect your teeth and gums. The doctor will give you an injection to make you feel sleepy and relaxed.

A flexible tube (called an endoscope), thinner than your little finger and with a bright light on the end, will then be passed through the mouth guard, over your tongue and down into your stomach. Some air will be passed through the tube into your stomach to give the doctor a clear view where the new feeding tube will be placed.

A local anaesthetic injection is given in the skin between your navel and breastbone, and a needle and small tube will be introduced through the skin and into the stomach.

The endoscope is removed and replaced by the soft plastic feeding tube, which is drawn down into your stomach and positioned through the prepared opening. The tube is a similar diameter to a biro pen. This procedure will take approximately 20 minutes.

Sedation

Sedation may make you drowsy and you may not remember the procedure taking place. However, it is not a general anaesthetic.

After the procedure you may wake up quickly, or more slowly – each person reacts differently.

The effects of the sedation will not wear off totally for 24 hours. Your thinking processes and movements may be slower than usual during this time. If you are having a day case PEG you must have a responsible adult with you for the next 24 hours. They will need to come and collect you from Queens Day Unit to meet with the

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nutrition nurse for some additional advice before taking you home.

For the first 24 hours after having sedation you should not:

• drive a car.

• operate any machinery – not even a kettle.

• drink alcohol.

• sign any legally binding documents.

The effects of the test and injection should have worn off after 24 hours when most patients are able to resume normal activities.

After the procedure

You will be left to rest in the unit for at least 4 to 6 hours. Occasionally the back of your throat may feel sore for a day or so. You may also feel bloated if some air has remained in your stomach. Both these discomforts will pass. Some people experience pain and soreness around the PEG tube for a few days after insertion. This is normal and we would recommend that you take regular painkillers as instructed.

IF you have severe pain - this is a red flag and you need you seek urgent medical attention.

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Feeding

Fluids will first be introduced through the tube 4 hours after the tube has been inserted.

A regime of feeding will be established and you and other helpers (if needed) will be shown how to give the feeds. It should then be possible for you to receive nourishment through the tube every day for as long as it is needed.

Care of the tube

You and other helpers will receive teaching on how to look after the tube. Once the tissues have healed, it is possible for the tube to be replaced if necessary. The tube can easily be removed when it is no longer required.

The tube which we normally use generally lasts for several years before needing changing.

IIf you need further information about your procedure, please telephone the nutrition nurses on 0117 342 7253 between 8am and 4pm, Monday to Friday.

Alternately, you can also contact the Endoscopy Unit on:

0117 342 7981 between 9am to 5pm, Monday to Friday

For further information and support on PEG tubes please visit the PINNT website at:

www.pinnt.com

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How can I give positive feedback, make a complaint, comment or suggestion?

Speak to a member of staff.

Talk to the patient support and complaints team by calling:

0117 342 1050.

If you have a complaint, please write to:

The patient complaints manager University Hospitals Bristol and Weston NHS Foundation Trust Trust Headquarters Marlborough Street Bristol BS1 3NU

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Notes

Bristol switchboard: 0117 923 0000

Weston switchboard: 01934 636 363

www.uhbw.nhs.uk

For an interpreter or signer please contact the telephone number on your appointment letter.

For this leaflet in large print or PDF format, please email patientleaflets@uhbw.nhs.uk.

Help us prevent the spread of infection in hospital. Please make sure your hands are clean. Wash and dry them thoroughly/use the gel provided. If you have been unwell in the last 48 hours please

consider whether your visit is essential.

For access all patient leaflets and information please go to the following address:

http://foi.avon.nhs.uk/

As well as providing clinical care, our Trust has an important role in research. This allows us to discover new

and improved ways of treating patients.

While under our care, you may be invited to take part in research. To find out more please visit: www.uhbw.nhs.uk

© University Hospitals Bristol and Weston Published: 11/03/22 Expires: 31/03/25 SHAN/QDU/HAVPEG/MAR22

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