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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 provided in thisorbooklet, please contact a member of If you have any questions are unsure about any of the the GI teamprovided on one ofinthe below. information thisnumbers booklet, listed please contact a member of the GI team on one of the numbers listed below. 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. 2 11 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. 10 3 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. 4 9 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. 8 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. 5 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. 6 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. 7