Download Percutaneous Endosopic Gastrostomy

Percutaneous Endosopic
Gastrostomy - PEG
Gastroenterology
Patient Information Leaflet
Originator: Pat Mcgainharding
Date: May 2011
Version: 3
Date for Review: May 2014
DGOH Ref No: DGOH/PIL/00396
Contact numbers
If you have any questions or are unsure about any of the
information
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contact a member of
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Russells Hall Hospital - GI Unit
Tel:
01384
244113
or via
Tel: 01384 456111.
Russells
Hall
Hospital
- GIswitchboard:
Unit
Tel: 01384 244113 or via switchboard: Tel: 01384 456111.
Ask to speak to the nurse in charge. If the nursing staff are unable
to address
your
questions,
will suggest
alternative
contacts.
Ask
to speak
to the
nurse inthey
charge.
If the nursing
staff are
unable
to address your questions, they will suggest alternative contacts.
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Can I find out more?
What is a PEG and why do I need one?
The Department of Health has more information about consent
available on the DoH website:
A Percutaneous Endoscopic Gastrstomy or PEG is a feeding tube
inserted directly into the stomach through the abdomen.
www.dh.gov.uk
A PEG is used to provide nutrition to patients who cannot take
sufficient amounts of food by mouth to stay healthy. It may also be
used to administer medication. The PEG may be in place
temporarily or for long term use and may replace a nasogastric
tube you may already have.
If you have any questions regarding your procedure please contact
the GI Unit on 01384 244113.
Placing a PEG for either temporary or permanent use is an
important decision to make and will be discussed with yourself in
detail beforehand by the doctor looking after you.
What does the procedure involve?
An endoscopic examination (Gastroscopy) of your gullet,
stomach and duodenum will be performed before the PEG is
inserted in to your stomach.
A thin, flexible tube with a light at the tip (Gastroscope) is
passed through the mouth. This highlights the stomach
showing us the best place to insert the PEG.
Air is passed down a channel within the gastroscope, the air
may make you feel full and want the belch. The procedure
does not hurt, but may make you feel a little uncomfortable for
a short time.
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What preparation will I need?
Consent
You should refrain from eating or drinking for 6 hours prior to your
procedure. Please wear loose fitting clothes - a shirt or blouse and
trousers are ideal. If you wear glasses or dentures you will need to
remove them before the start of the procedure.
You will need to give consent before the doctor or health
professional examines or treats you.
How will the procedure be conducted?
You will be asked to lie on your back on a patient trolley with
your head supported by pillows.
A cannula (small needle) will be placed in your arm or the
back of your hand in order to give you some sedation.
A mouth guard will be placed between your teeth in order to
let the gastroscope pass. This protects your teeth and also
prevents you from biting the gastroscope.
You will be given oxygen through a small tube placed just
inside your nose and you will be monitored by nurses
throughout the procedure.
The gastroscope will be gently passed through your mouth,
you may be asked to swallow in order to allow the
gastroscope to pass.
Your stomach will be examined in order to find a suitable
place in which to insert the PEG.
As part of your treatment some kind of photographic record may be
made - for example; clinical photographs, video recordings or x ray.
You will be told if this is likely to happen. The photographs or
recordings will be kept with your notes and will be held in
confidence as part of your medical record. This means that it will be
normally be seen by only those involved in providing you with care
or those who need to check the quality of care you have received.
The use of photographs is extremely important for other NHS work
such as teaching or medical research. However, we will not use
yours in a way that allows your identify to be recognised without
your express permission.
You will be asked to sign a consent form once the procedure has
been discussed with you. Health professionals must ensure that
you know enough about the procedure beforehand, and that you
are fully aware of the benefits and risks of the procedure.
Once the consent form is completed you will be given a copy to
keep.
If you later change your mind, you are entitled to withdraw consent
after signing.
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Who is treating me?
Amongst the health professionals treating you, there may be a
doctor in training, medically qualified but now doing more specialist
training. They range from recently qualified doctors to doctors
almost ready to be consultants. They will carry out procedures for
which they have been appropriately trained. Someone senior will
supervise - either in person accompanying a less experienced
doctor in training or available to advise someone less experienced.
Should I ask questions?
Ask anything you want to. The person you ask will do his/hers best
to answer your questions. If they do not know they will find
someone else who is able to discuss your concerns.
Is there anything I should tell people?
If there is any procedure you DO NOT want to happen, you should
tell the people who are treating you. It is important for them to know
about any illnesses or allergies which you have suffered from in the
past.
Remember to tell the team about anything that concerns you or
anything which might affect your general health.
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Once a suitable place has been found, you abdomen will be
swabbed with an antiseptic solution and a local anesthetic will
be injected into the abdomen.
A small incision will be made in the abdomen and the PEG
tube will be passed into the stomach. Because of the numbing
effect of the local anesthetic this insertion should not hurt. The
tube is narrow and flexible and is not uncomfortable. When
the PEG feeding tube is not in use it is easily concealed under
your normal clothing.
Once the PEG has been placed, the gastroscope will be
gently removed. A small dressing will be placed over the
feeding tube.
What are the risks of a PEG?
Inserting a PEG is an important decision and complications can
occur. Many patients are already quite unwell and the use of
sedation increases the already high risk of aspiration pneumonia.
Infection around the insertion site and inside the abdomen can
occur but preventative antibiotics are given at the time of placing
the PEG in order to reduce the risk of infection.
While the skin around the insertion is healing, the skin may appear
red or moist. However, do report any significant change in
appearance or discomfort as sometimes infection may develop and
you may require antibiotics (this is quite rare). Your nurse (either
hospital or community) will check the tube regularly.
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Bleeding can occur from the skin or into the stomach but this rarely
more than a minor problem.
Perforation of the bowel leading to peritonitis is rare but may
require emergency surgery.
The risk of death as a result of a PEG procedure depends on the
underlying reason for the PEG and the condition of the patient.
These risks must be weighed against the risk of dying without
adequate hydration or nutrition if a PEG is not inserted.
How do I take care of my PEG?
There will be a team including Nutrition nurses and dietitians
involved in your care; you may have met some of them beforehand.
They will ensure that you (or your careers) are able to look after
your PEG and connect the feeds when you go home.
DO NOT put anything down the tube that is not prescribed by your
doctor as some medications may cause blockage and should be
avoided.
DO NOT tug on the tube as this may cause it to become fixed and
result in surgical removal.
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What happens after the procedure?
When your procedure has been completed you will be taken into
the recovery area to rest. You will be monitored by the nursing staff
taking care of you.
You may need to stay in recovery for up to 2 hours after your
procedure, depending on your recovery time. You should expect to
be ready for discharge home straight after this time, providing you
have gained full awareness and your recovery has been straight
forward. If you are in hospital, you will be taken back to the ward
almost immediately.
Before you are discharged home you will be given after care
instructions and information about how to look after your PEG and
feeds.
You will require a responsible adult to take you home and stay with
you overnight. You will not be allowed home on public transport.
You may not by law be in charge of a motor vehicle or moving
machinery for 24 hours after the procedure.
The effect of the sedation may be prolonged by other medication
you may be taking.
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