A PEG means placing a feeding tube into the stomach through the skin, using endoscopy. When a child needs to be tube-fed for more than two months, it is better to have a PEG placed. Before a PEG is placed, note the following:
- The necessary tests, as advised by the doctor, must have been done and seen by the doctor (blood tests, contrast X-ray of the digestive tract, etc.).
- The patient should be admitted to the gastroenterology ward the day before the PEG is placed and should have nothing by mouth or through the tube from 12 midnight. 3. If the child takes medicines (anticonvulsants, etc.), be sure to tell the doctor on admission so that, if necessary, they can be given temporarily by injection. 4. Disorders of blood clotting, displacement of the abdominal organs and sometimes curvature of the spine, a ventriculoperitoneal (brain-to-abdomen) shunt, peritoneal dialysis, an enlarged liver and spleen, previous abdominal surgery, and severe digestive problems found at endoscopy, especially oesophageal varices and stomach ulcers, may make it impossible to place a PEG.
5. Note that the PEG is placed only to make feeding your child easier; it plays no part in improving oesophageal reflux, brain involvement, seizures, etc. 6. The PEG placed for your child can be used for about 1–2 years.
After the PEG has been placed, note the following:
- 1. Do not feed through the PEG for 6 hours. Then first give a few cc of water or ORS, and then gradually give fluids through it.
2. The dressing on the PEG must stay in place for 48 hours.
After the dressing is removed, clean the PEG and the area around it with warm water and soap at least once a day, before a feed or one hour after a feed, and cover the area around it with clean gauze; there is no need to use antiseptics. 3. If there is pain in the first two days, use painkillers. 4. From the second day after the PEG is placed, twice a day, gently pull the tube towards you and turn it 360 degrees. 5. Bathing is allowed after 48 hours, but always take care that the PEG is not pulled. 6. In the first 7–10 days, a little discharge around the PEG is normal. 7. Before and after each use of the PEG, flush the tube with warm water (5–10 cc).
Do not use soft drinks, etc. for this. 8. After the first week, twice every day, after cleaning the tube and the disc, first slide the disc 2 cm up the tube. Then push the tube into the stomach, turn it one full turn, then pull the tube back out by the same amount and return the disc to its place.
- Give food through the main tube and medicines through the angled side tube.
- Redness without discharge, up to the size of a small coin (about one centimetre in diameter), is normal and needs no special action.
- If there is severe redness and skin irritation around the PEG, use stomach acid-reducing medicines (ranitidine, omeprazole, etc.) as advised by the doctor.
- If you feel too much pressure when feeding through the PEG, gently flush the tube with a little warm water; if this does not work, or if the child cries when the tube is used, see a doctor. 13. In infants, half an hour after each feed, let the air out of the stomach through the PEG using a small syringe. 14. As far as possible, give part of the child's feeding by mouth, or at least use a dummy (pacifier) and exercises that strengthen swallowing, so that the child does not forget how to swallow.
- 15. When the child is ill, as far as possible use liquid medicines or tablets that dissolve in water to treat the child.
Do not give coated tablets, enzymes, laxatives, calcium carbonate, iron, potassium, phenytoin or clarithromycin through the PEG. 16. Brush the child's teeth at least once a week. If the lips are dry, use petroleum jelly (Vaseline) or lip balm. 17. If the PEG falls out, fluids cannot pass through the tube, or the child has severe abdominal pain, repeated vomiting, or bleeding or discharge from the site, see a doctor immediately.
Some common conditions in which a PEG tube may be recommended include: birth defects; premature babies who cannot suck milk; swallowing disorders; stroke; cancer of the mouth or oesophagus; diseases of the oesophagus. A PEG tube is also recommended if you have a long-term physical condition that makes swallowing difficult or impossible for you.
Prepared by: Narges Bagherizadeh