An introduction to PEG feeding

What is PEG feeding?

This article will provide you with an introduction to PEG (percutaneous endoscopic gastronomy) feeding, a form of enteral artificial feeding.

  • Percutaneous: something (e.g. a tube) that is inserted via the skin.
  • Endoscopic: name of the instrument used to insert the tube.
  • Gastrostomy: an opening into the person’s stomach.
  • Enteral: uses the body’s natural digestion process of the gastro-intestinal tract despite bypassing the mouth. This is different from parenteral which by-passes the gastro-intestinal tract.
  • Artificial feeding: used for people who cannot eat or drink enough to keep them healthy. Other forms of artificial feeding include NG (naso-gastric) or TPN (total parenteral nutrition).

Patients who receive PEG feeding will have a PEG tube (also known as a gastrostomy tube) inserted directly into their stomach. The tube allows all food, fluids and medications to pass directly into the digestive tract.

When is PEG feeding used?

  • As a PEG tube goes directly into the stomach it can be used for people who have difficulty swallowing food or liquids (e.g. after a stroke).
  • It can also be used if there is a risk of ‘aspirating’ on foods - this is when foods ‘go the wrong way’ and can end up in the patient’s lungs causing problems (e.g. patients with advanced dementia and cystic fibrosis).
  • PEG feeding allows people to receive all the essential nutrients, maintain a healthy weight and improve overall wellbeing and quality of life. It can sometimes be used when people are unable to take in adequate nutrition themselves, e.g. if someone has severe anorexia.  
  • Though PEG feeding was initially developed for children, it is now commonly used for both adults and children of all ages.

The decision to insert a PEG tube will always be made on an individual basis following discussions with the patient and the multi-disciplinary team.

The benefits of PEG feeding

When someone only needs temporary enteral tube feeding it is sometimes possible to pass a thin tube through the nose into the stomach (NG feeding).

However, if the person requires longer-term enteral feeding, PEG feeding may be considered.

In general, PEG tubes:

  • Are better tolerated than NG tubes.
  • Have fewer interruptions and are easier to use.
  • Have fewer risk / complications than NG tubes.

The PEG tube is often more comfortable and is relatively straightforward to care for and manage at home. Many people opt for a PEG tube as they are a discreet option, which can be easily hidden under clothes.

Insertion of the PEG tube

On the day of the procedure, patients should not eat for six hours and will need to stop drinking clear fluids two hours before the procedure.

In most hospitals, once the patient arrives on the ward a cannula or small needle will be placed in the arm or hand, before being moved through to a dedicated Endoscopy Unit. The procedure does not require a general anaesthetic, although some patients may be given a sedative.

A mouth guide will be positioned in the patient’s mouth, and the endoscope then passes through the mouth into the stomach. Throughout the procedure suction equipment is used to remove saliva and other secretions from the throat.

An antiseptic solution and local anaesthetic will be applied to the patient’s stomach. The tube is then placed into the stomach with an exit made through the abdominal wall. A small plastic disc on both the inside and outside stops the tube from becoming dislodged, with the whole procedure usually taking between 20-30 minutes.

Following the PEG procedure

  • Usually, patients can receive their first feed after approximately four hours.
  • Nurses or specially trained healthcare assistants will use a syringe or an electronic machine (referred to as a ‘pump’) to administer food, fluids and medications.
  • A qualified dietician will work with the healthcare team to establish the correct diet for each individual patient, as everyone will have varying nutritional requirements.
  • It can take a few weeks for the site to initially heal. Its important that all staff (or the patient if they are able) know how to care for the insertion site and keep it clean.

Complications 

The insertion procedure:

  • During the operation there are risks associated with making a hole in the stomach and passing the endoscope through, which could result in an operation.
  • Ihe procedure is considered to be safe with major complications only seen in rare cases.
  • According to The Queen Elizabeth Hospital in Birmingham, [https://www.uhb.nhs.uk/pdf/PiHavingPegInserted.pdf] around 3% of patients suffer from major complications after the procedure, with a mortality rate of between 0.7-2.1 percent. The complications range from breathing problems and bleeding to bowel perforation and inflammation within the abdomen.

PEG feeding:

  • There is a potential for discomfort if the food is not administered carefully as it can lead to pain, nausea and infection.
  • The most common examples of complications during PEG feeding are blockages and the skin around the tube area beginning to swell.

Guidelines for PEG feeding

If you are caring for a patient with a PEG tube you must pay meticulous attention to hand hygiene and other aspects of infection control.

  • Wash your hands carefully and always wear gloves and an apron, when administering the food or carrying out a task which involves touching the tube
  • The tube and the surrounding area must be cleaned each day with soap and water and thoroughly dried.
  • The tube should also be flushed before and after each enteral tube feeding, to reduce the risk of blockages or infections developing.

Training
Food which is administered via a PEG tube is classed as prescribed medication, so it requires adequate professional training. 

A PEG training course will provide you with the skills and knowledge needed to provide safe and comfortable care for patients with a PEG tube.

It is likely that a training course will involve a practical session, which will introduce participants to the variety of equipment required. This will be supported through knowledge-based learning, which will cover topics such as identifying complications, care and maintenance of the PEG site and the procedures needed for effective mouth care.

Interested in learning more? View all Peg Feeding training courses here