PEG tube insertion: what happens, risks and aftercare

A PEG delivers feed, water and medicines straight into the stomach when swallowing is unsafe or when disease prevents enough food reaching the gut. North Tees describes people who cannot eat normally because of illness, disease of the digestive tract or swallowing difficulty, such as after a stroke. It says PEG feeding is considered an appropriate route for people who will be unable to eat normally for more than two to four weeks.

For shorter spells, feeding through a tube passed through the nose (a nasogastric tube) is usual; Milton Keynes mentions pausing nasogastric feeds before the procedure. A PEG may not be needed if swallowing is expected to recover quickly, and in some advanced illnesses a team will discuss with the person and family whether tube feeding fits their wishes and goals of care.

North Tees describes admission for routine checks and blood tests, antibiotics around the procedure and stopping anticoagulants five or more days beforehand. Milton Keynes says blood thinners may need to be adjusted or paused, and that people with diabetes should speak to their specialist nurse about fasting.

Both leaflets give a 6-hour fast. Routine medicines may be taken with water as usual in one leaflet. The nutrition and dietetics team is involved in the feeding plan, and the nursing team explains how to look after the tube.

In the endoscopy unit you receive a throat spray or local anaesthetic and sedation through a cannula, with oxygen. A flexible camera is passed through the mouth into the stomach. Milton Keynes says the doctor uses it to inspect the stomach and choose the right place for the tube, and North Tees says a small opening is made in the abdomen and the tube inserted and secured.

It takes about 20 minutes according to North Tees and about 30 according to Milton Keynes. Afterwards the Milton Keynes leaflet asks for four hours of bed rest and nothing by mouth, then a sterile water flush, with feeding beginning the next day if all is well. North Tees describes a hospital stay of typically three days after insertion.

The leaflets list a reaction to the sedative, aspiration of stomach fluid into the lungs, infection at the site, bleeding and perforation. North Tees quotes over-sedation at 1 in 100, bleeding at 1 in 1,000 and perforation at 1 in 15,000; Milton Keynes calls perforation rare and says it may need antibiotics, a hospital stay and sometimes surgery.

Later problems include the tube being dislodged, infection at the wound, over-granulation tissue around the opening, leakage and blockage. Only the special liquid feed, water and liquid medicines should go down a PEG; North Tees specifically says ordinary food should not be liquidised and passed down it.

North Tees says people should not make important decisions, sign legal documents or lock the bathroom door for 12 hours after sedation. Look after the site as the nursing team instructs you. Milton Keynes describes a 45-degree sitting position during feeds to lower the chance of nausea.

A dietitian and community nursing team arrange the feeding regimen, equipment and supplies. Many people are able to go home with the tube in place and carers trained. Driving is a separate question depending on the underlying illness and sedation; GOV.UK says you must tell the DVLA if you are unable to drive three months after an operation.

North Tees tells people to seek help for severe neck, chest or abdominal pain, a temperature above 38 C, vomiting or nausea, or if the tube falls out. Milton Keynes adds leakage around the tube, pain during feeding or flushing, severe pain with bloating and new bleeding from the site. Contact the ward, your community nurse or dietitian, or NHS 111; call 999 for collapse, severe breathlessness or heavy bleeding.

• Is a PEG the right choice now, or would a nasal tube bridge the gap?

• How long do you expect the tube to be needed?

• What happens if my condition changes or I want it removed?

• Who supplies the feed and equipment, and who do I call if the tube blocks?

• Can I still eat or drink anything by mouth?

The procedure is the same wherever it is done. What differs is the support around it, so ask any provider who will supply feed and equipment, who handles problems after discharge and who arranges tube care in the community before you agree.