Download Percutaneous Endoscopic Gastrostomy (PEG) removal

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Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614,
Nottingham NG7 1BR
www.nuh.nhs.uk
Percutaneous Endoscopic
Gastrostomy (PEG) removal
Endoscopy Department
Information for patients
If you require a full list of references for this leaflet please email
[email protected] or phone 0115 924 9924
ext. 67184.
The Trust endeavours to ensure that the information given here
is accurate and impartial.
This document can be provided in different languages and
formats. For more information, please contact:
The Endoscopy Centre
City Hospital campus: 0115 9628034
QMC Hospital campus: 0115 9249924 ext. 64387
Lorraine Clark (Gastroenterology & Endoscopist Nurse Lead), Tracey Buchanan (Nutrition
Nurse Specialist) Endoscopy Department © October 2013. All rights reserved.
Nottingham University Hospitals NHS Trust. Review May 2016. Ref: 1494/v2/0514/AS
NUH02595N
This leaflet aims to explain what a PEG removal involves. It will
answer frequency asked questions for you.
Why do I need my PEG removed?
You are now able to meet your nutritional requirements by
mouth and do not use your PEG tube for feeding therefore it is
best the PEG tube is removed to avoid any complications or
infections.
What is a PEG removal?
This is the permanent removal of the PEG tube, this includes the
removal of the internal bumper and the external part of the
feeding tube (the whole tube is removed)
How is the PEG removal?
The PEG is removed in Endoscopy by an endoscopist and this
is done by passing a long flexible tube with a camera in the tip
known as an endoscope (thinner than your little finger) through
your mouth and into your stomach. A PEG removal procedure
allows the endoscopist to look into your stomach and see your
PEG tube from the inside of your stomach, which is essential to
be able to remove the internal bumper that holds your PEG tube
in place. The tube will be cut from the outside next to your skin
and this will allow the endoscopist to remove the whole of the
tube including the internal bumper
Are there any alternatives to an endoscopy PEG
removal?
Endoscopy PEG removal is the most simple way of removing
your PEG tube. There are other methods but there is a potential
risk of causing bowel obstruction.
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Notes/questions Section (cont)
PLEASE WRITE YOUR RELATIVE’S/FRIEND’S
NAME AND TELEPHONE NUMBER BELOW:
Name:
Telephone No:
CHECKLIST
Things to remember before your PEG
Nothing to eat for 6 hours before your procedure and/or do
not use your PEG tube for 6 hours before the procedure.
Nothing to drink from 2 hours before your procedure.
Check for specific medication instructions.
Transport arrangements made. Plus contact name and number written in this booklet.
Responsible adult arranged to stay with you for 12 hours if
you are thinking about having sedation and to be discharged
home that day, e.g. if you normally live in a Nursing Home.
Bring all this information pack with you to your endoscopy
appointment.
Notes/questions Section
Please write down a list of any medications you are taking
and any questions you have:
How do I prepare for the test?
It is advised that you wear loose fitting clothing, as this is more
comfortable for you after the test.
To allow a clear view during the test, your stomach must be
empty. Therefore do not have anything to eat for at least 6
hours before the procedure. Please do not use your feeding
tube 6 hours prior to the procedure
If appropriate, you may have sips water up to 2 hours before
the procedure unless it is deemed unsafe for you to take
fluids by mouth.
Please remove any coloured nail varnish, as this may affect
how well our monitoring equipment is able to detect your
heart rate and breathing during your endoscopy test.
What about my medication?
Please list your usual medication on the Notes/Questions
section at the back of this booklet.
Specific instructions have been put into your information pack:
If you are Diabetic – see green leaflet
If you take Warfarin or Clopidogrel – see pink leaflet
Take any other medication as normal.
Any essential medication can be taken up to 2 hours before the
procedure if unsure please contact the endoscopy centre.
NOTE
If you take steroids or immuno-suppressant medication, please
bring your Alert Cards with you. If your doctor has told you that
you may have had a stroke or heart attack within the last 3
months, please contact the Endoscopy Unit as soon as possible.
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What happens when I arrive?
What happens after the procedure?
On arrival, please report to the main reception desk where the
receptionist will check your personal details.
You will then be greeted by the nurse responsible for your care
and escorted to the assessment area. Here you will be asked a
number of questions, including your medical history and your
arrangements for transport home. The nurse will also take your
pulse and blood pressure.
After the procedure, you will remain on the trolley and will be
taken to the recovery area. Here you will be allowed to rest
until you are safe to return to the ward area if you are going
to stay in the hospital.
If there is a possibility that you are going to have sedation the
nurse will discuss this with you, you will not be allowed to use
public transport or drive. You must arrange for a responsible
adult to collect you, even if going home by taxi.
It is also strongly recommended that the responsible adult
should stay with you for 12 hours following the sedation for
your own safety.
You will then be asked to wait in the sub-waiting area before
being called through for your PEG removal. Please note there
often are several endoscopy procedure rooms running at the
same time with different procedures and endoscopists. If
another patient is called through from the sub-waiting area for
their procedure before yourself they are not jumping the queue.
You may feel a little bloated or have some discomfort in your
stomach, this will wear off during the day. If the hole/stoma
site continues to leak after 5 days please contact the
nutrition nurse specialist :
City Campus 0115 9691169 ext 56754 or bleep via
switchboard 6993
Queens Campus 0115 9249924 ext 61036 or bleep via
switchboard 6417.
After you are discharged home
If you experience any of the following problems please
contact your GP immediately, informing them that you have
had a colonoscopy:
A severe abdominal pain (not just cramp caused by wind)
A sudden passing of a large amount of blood from your
back passage (for a very small amount of blood take no
action)
A firm and swollen abdomen
High temperature or feeling feverish
Vomiting
Alternatively, contact the Endoscopy Unit at the hospital
campus where you had your colonoscopy:
City Hospital Campus
8am - 6pm, Monday to Friday
Tel: 0115 9628007
QMC Campus
8am - 6pm Monday to Friday
Tel: 0115 9249924 ext 64490
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Are there any complications?
As with every medical procedure, the risk must be compared to
the benefit of having the procedure carried out: the doctor who
has requested the procedure will have considered this very
carefully. A removal PEG is what is known as an invasive
procedure and, therefore, carries risks/complications. These
are rare.
The major risks/complications include:
Allergic reaction to the equipment or medication used for the
procedure.
Disturbance of your heart rate and breathing.
Wound infection (1 person in every 10 procedures carried
out).
Inflammation of the peritoneum (a lining of the abdominal
cavity).
Chest infection (1 person in every 100 procedures carried
out).
Significant bleeding (less than 1 person in every 1000
procedures carried out).
Perforation (small tear or damage to the lining of the gullet or
stomach (less than 1 person in every 10,000 procedures
carried out). This may require surgery.
More about Sedation and Throat Spray
Sedation
This will make you sleepy, but not unconscious. It is NOT a
general anaesthetic. You will be in a state called co-operative
sedation: this means that, although drowsy, you will still hear
what is said to you and will be able to carry out simple
instructions during the test.
You will be relaxed and should be able to breathe quite normally
during the procedure. Sedation has an amnesic effect (making
you forgetful for a short time); the chances therefore of you
remembering anything about this investigation are very unlikely.
It is very important that you understand – if you decide to have
sedation you SHOULD NOT drive, operate heavy machinery or
sign any legal documents for 24 hours following the procedure.
You must also not drink any alcohol for 8 hours before or after
the test if you plan to have sedation.
Throat Spray
This is a local anaesthetic spray. It may taste unpleasant, but is
intended to make your throat less sensitive and numb during the
test.
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So what does removal of a PEG involve?
You will be introduced to the nurses and endoscopists who
will be with you throughout the removal of your PEG.
An endoscopist will then check that you have a full
understanding of your procedure, all that is involved, and that
you are willing to go ahead.
The endoscopist will also examine your abdomen to check
that it is safe to go ahead with the procedure and also check
the PEG rotates and retracts freely.
You and, if you wish, your relatives will be given the
opportunity to discuss whether to have sedation and how it
may affect you.
You will be asked to remove any dentures and/or spectacles
and these will be stored for safe keeping under the trolley
that you are lying on.
At this point, most people have the back of their throat
sprayed with a local anaesthetic spray, whilst they are sitting
up.
A needle will be put into the back of your hand or a vein in
your arm, through which the sedative will be given.
In order to monitor your heart rate and breathing, the nurse
looking after you will place a monitor onto one of your
fingers. A nurse will be with you at all times, giving guidance
and support. Any saliva you produce will be removed with a
small suction tube, similar to that used at the dentist.
You will be able to breathe normally throughout your
procedure.
The flexible endoscopy tube will then be passed over the
back of your tongue, down your gullet, into your stomach.
Air is put into your stomach so that a clear view of the lining
of your stomach can be seen and identify the internal
bumper of your PEG. This may cause you to feel bloated
during or after the procedure. This is normal and should
resolve on its own.
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Once we have located the internal bumper a snare (looped
device) will be passed down the endoscope and around the
internal bumper. This is so we can remove the internal
bumper from your stomach.
The PEG tube will be cut on the outside near to the insertion
site. Once the tube has been cut the internal bumper will be
removed by removing the endoscope and snare through your
mouth.
The procedure should take about 10 minutes to complete.
Within 24-48 hours the hole/stoma site where your Peg was
sited will close. A dressing will place over the hole/stoma site
to prevent any leakage onto your clothes.
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