Feeding Gastrostomy Tube Placement

What is a feeding gastrostomy tube?
A feeding gastrostomy tube (also called a percutaneous gastrostomy (PEG tube or G-tube) is a tube inserted through the abdominal wall and into the stomach to assist with feeding and to provide nutrition.

Why is it ordered?
A feeding tube is ordered for the patient who is unable to take in enough food or drink through the mouth to maintain his or her body weight. The same type of tube can also be used to remove air or liquids from the stomach.

What should my health care professional know before I have this procedure done?

• If you have allergies to:
  • Any medications, specifically antibiotics and sedatives (sleeping medicines)
  • Any numbing medication (ex: lidocaine benzocaine)
  • Latex
  • Contrast dye or iodine (if you have an allergy, your doctor may have you take steroids 24 hours before the procedure or use barium or air instead of contrast dye or iodine)
• If you have any blood clotting or bleeding problems or if you are taking aspirin, ibuprofen, or any blood thinners such as heparin, warfarin (Coumadin®), enoxaparin (Lovenox®), aspirin-dipyridamole capsules (Aggrenox®), or clopidogrel (Plavix®).
• If you are unsure about your medications, please discuss this with your primary physician.

Do I need anything to get ready for this procedure?

• You cannot eat or drink anything after midnight the night before the procedure.
• Do not take any blood thinners for at least seven days prior to the procedure. If you are unsure about your medications, please discuss this with your primary physician.
• You should have current blood work (blood clotting studies and a blood platelet count).

Where is this done?
Most often: in the GI Endoscopy suite, Duke North Hospital, zero level or in the operating room
Occasionally: in Vascular Interventional Radiology or the intensive care unit.

What is involved in placing a PEG tube?
The procedure varies, depending on where the tube is inserted. Your tube will be inserted in:

GI Endoscopy
Before the procedure, the staff will:

1. Have you sign a consent form for the procedure, indicating that the purpose, benefits, risks and alternative have been explained to you. If you are unable to consent for yourself, consent will be sought from your next-of-kin, or court-appointed guardian or a healthcare agent appointed in accordance with a valid health care power of attorney.  
2. Assess your medical history and evaluate your blood work to make sure your clotting values are normal.
3. Insert an IV and may give you a dose of antibiotics.
4. Shave the left upper part of the abdomen, if needed.

During the procedure, the staff will:

1. Give you medicine to make you sleepy and then numb your throat so you will not gag with the placement of the endoscope
2. Monitor your blood pressure, heart rate, and oxygen saturation. You will receive oxygen throughout the procedure, if needed.
3. Perform an endoscopy (a small tube with a light and camera on the end of it is put down your esophagus and into your stomach). The endoscopy lets the doctor look at the stomach from the inside and determine where to place the feeding tube.
4. Clean the abdomen with an antiseptic solution and numb the skin. A tiny incision is made and the tube is placed through the skin, or percutaneously, with the aid of the endoscope. The procedure lasts about 45 minutes to one hour.

Vascular Interventional Radiology
Vascular Interventional Radiology places gastrostomy tubes only in inpatients.

The day before the procedure, the staff will:

1. Have you sign a consent form for the procedure, indicating that the purpose, benefits, risks and alternative have been explained to you. If you are unable to consent for yourself, consent will be sought from your next-of-kin, or court-appointed guardian or a healthcare agent appointed in accordance with a valid health care power of attorney.  
2. Assess your medical history and check your blood work to make sure your clotting values are normal.
3. Insert a nasogastric (NG) tube. This may be used to put in the barium liquid used to show where your stomach and intestines are, by x-ray. It is also used to put air into the stomach before the procedure.

The morning of the procedure:

• You will have an x-ray done of your abdomen. This may be done in your hospital room, or in Vascular Interventional Radiology.

Before starting the procedure, the staff will:

1. Insert an IV, if you don’t have one already
2. Begin monitoring your blood pressure, heart rate, and oxygen saturation.

During the procedure, the staff will:

1. Give you medicine to make you sleepy
2. Continue monitoring your blood pressure, heart rate, and oxygen saturation. You will receive oxygen throughout the procedure, if needed.
3. Shave the left upper part of the abdomen, if needed.
4. Clean the abdomen with an antiseptic solution
5. Numb the skin.
6. Inject air into the stomach through the NG tube.
7. Attach a T-fastener to hold the tube in place, using a needle
8. Make a tiny incision and place the tube through the skin into the stomach.

The procedure lasts about 45 minutes to one hour.

Duke North Operating Room (Ambulatory Surgery)
Before the procedure:

1. You will be seen by the general surgeon in the clinic for a pre-op evaluation. The surgeon will assess your medical history and evaluate your blood work to make sure your clotting values are normal. During this visit, you will sign a consent form for the procedure, indicating that the purpose, benefits, risks and alternative have been explained to you. If you are unable to consent for yourself, consent will be sought from your next-of-kin, or court-appointed guardian or a healthcare agent appointed in accordance with a valid health care power of attorney.  
2. You will also have an appointment to discuss your anesthesia in the Pre-op Screening Unit. During this visit, you will sign a consent form for the anesthesia.
3. You may not have anything to eat or drink after midnight the night before your procedure. During your pre-op screening visit, you will be instructed about taking your medications on the morning of surgery.

During the procedure, the staff will:

1. Insert an IV for medicines and fluids
2. Give you medicine to make you sleepy and then numb your throat so you will not gag with the placement of the endoscope
3. Monitor your blood pressure, heart rate, and oxygen saturation. You will receive oxygen throughout the procedure, if needed.
4. Perform an endoscopy (a small tube with a light and camera on the end of it is put down your esophagus and into your stomach). The endoscopy lets the doctor look at the stomach from the inside and determine where to place the feeding tube.
5. Clean the abdomen with an antiseptic solution and numb the skin. A tiny incision is made and the tube is placed through the skin, or percutaneously, with the aid of the endoscope. The actual procedure lasts only about five to 10 minutes. You will be in the operating room about 45 minutes to one hour.

Is the procedure painful?
You will be given sedation throughout the procedure, so you should be very comfortable. Most people do not remember anything about the procedure when they wake up. Some may complain of some mild discomfort during the procedure or at the tube site. If you cannot be adequately sedated, the procedure will be stopped. Your doctor will be notified and placement under general anesthesia will be considered.

What are the risks of the procedure?

• An allergic reaction to the medicine.
• Bleeding
• An unplanned tiny hole (perforation).
• Infection at the tube site or a fever.
• Infection inside the abdomen (peritonitis)
• The tube must not be removed or dislodged for the next two weeks to allow the tract to form where the tube has been placed. Dislodgement of the tube during the first two weeks following placement can cause leakage and infection. If this occurs you should contact your physician immediately. This is an emergency!

What happens after the procedure?
After the procedure, a dressing is placed over the tube. Sometimes an abdominal binder is applied to protect the tube. Then you will be taken to your hospital room or to the recovery area where you'll be for at least 30 minutes.

• If you are staying in the hospital, the nurse will give report to the nurse on the floor taking care of you. Once recovered, you will be discharged to your room. The nasogastric tube will usually be connected to suction for about 24 to 48 hours. A dietitian and/or floor nurse will discuss with you how to use your tube for feeding, how to take care of it at home, and what feeding solution is the best for you at that time.
• If you are going home, your driver can come and sit with you. Discharge instructions will be given. Your IV will be taken out. The doctor will come and talk to you or your family before you leave.
• The doctor who ordered your tube placement will make arrangements for your follow-up. You will need to see the doctor within 7 days for tubes placed in the operating room and within 14 to 21 days for tubes not placed in the operating room. Call your doctor if you have questions.
• You and your family may learn about taking care of the tube and doing feedings at home in several ways. You may have instructions in clinic before the tube is placed. Your family may receive instructions in the recovery room immediately after tube placement. Or, you may be taught in the clinic after the procedure or during a visit from a home health nurse. This teaching should be done within one to two days from the tube insertion. Please contact the doctor who placed your tube if you have questions about who will teach you how to use it.
• The tube cannot be used for 24 to 48 hours after insertion.

Gastrostomy tubes often need to be replaced. If cracked, leaking, or obstructed, it can often be replaced using the same opening.

Do I need someone to drive me home afterward?
If you are not staying in the hospital, then yes. You will be given sedation and you cannot drive for 24 hours after the procedure.

When do I need to call the doctor?
Your tube should be ready to use within 24 hours unless your doctor says otherwise.
If you have a problem with your tube, refer to the chart below.

This article is intended as a resource for patients receiving their cancer care at Duke University Hospital or Duke Clinic. It is not intended to substitute for medical advice from your healthcare team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.