Understanding the PEG Tube Placement Procedure
PEG tube placement is a safe procedure, but all surgeries carry some risks. Parents (legal guardians) will need to sign a consent form that explains the risks and benefits of the surgery and should discuss these risks and benefits with your child’s surgeon or gastroenterologist.
Some potential risks of PEG tube insertion include:
- Reactions to the anesthesia
- Pain at the incision site
- Leakage of stomach contents around the tube
- Infection of the tube site
- Infection that spreads inside the abdomen
- Bleeding from the incision area
- Bleeding or infection from damage to other organs inside the abdomen
- Blockage or dislodgement of the tube.
Although very rare, perforation into other organs and esophageal tears are possible.
There may be other risks, depending on the child’s specific medical condition. Be sure to discuss any concerns with the child’s surgeon before the procedure.
What to Expect Before the Procedure
In the days before the surgery, be sure to tell your child’s surgeon or gastroenterologist about any prescription medications, over-the-counter medications or herbal supplements your child may take. In some cases you may be asked to stop giving your child certain medications prior to the procedure. Also be sure to:
- Tell the doctor if your child or someone in your family has any history of reaction to anesthesia.
- Follow all instructions given on when your child cannot eat or drink prior to the procedure.
- Ask the doctor performing the procedure if your child should take their regular medications with a small sip of water.
- Dress your child in loose, comfortable clothing on the day of surgery.
- Try to find other arrangements for other children the day of the procedure. After the procedure, parents will be provided with a lot of information. It is important for parents to be able to focus on their child and learn as much as possible from the hospital staff before heading home.
What to Expect the Day of the Procedure
After being admitted to CHOC, your child will be provided a private room in the preop area in our Tidwell Procedure Center. There, your child will have an intravenous line (IV) started in his or her hand or arm to receive fluids and medications. You will meet with both the anesthesiologist and the endoscopist before the procedure begins. PEG tube placement is usually done under monitored anesthesia. Your child may be given pain medication and medication to make them sleepy through the IV. Antibiotics may also be given through the IV.
Because an endoscope is inserted down the child’s throat, a numbing medicine may be sprayed to prevent gagging and a mouth guard may also be inserted. The actual procedure takes about 20 minutes. This is what usually occurs during the procedure:
- The abdomen is cleaned and a numbing medication (local anesthetic) is injected.
- The endoscope is passed through the child’s mouth into the stomach.
- A small surgical cut is made through the skin and carried down into the stomach.
- The PEG tube is inserted through the opening while the surgeon or gastroenterologist watches through the endoscope.
- The tube is held in place inside the stomach with the help of a special bolster.
- A small dressing is placed at the new opening.
What to Expect After the Procedure
After the procedure, your child is taken to the recovery area to recover from the anesthesia. Some patients go home the same day while others may stay overnight at the hospital for observation.
After surgery most patients:
- Experience pain at the incision, cramping or gas pain. You will be provided information on pain control prior to going home.
- Your child can usually have the dressing over the incision area removed after one or two days.
- The incision area will heal in about five days. Patients and their caregiver will be taught how to clean the area daily with soap and water. After cleaning, the area should be dried and covered with a small gauze pad.
- Your child should be able to gradually return to normal activities, depending on their overall condition. You will be provided with activity restrictions before going home.
- Begin using the PEG tube for feeding gradually with clear fluids and progress to special formula feedings.
Before heading home from the hospital, be sure to ask your child’s health care team the following:
- When your child can start showering and bathing
- How to care for the skin around the tube
- What symptoms to look for that could indicate an infection
- How to empty your child’s stomach
- What to do if the tube gets blocked
- What formula to use and how to feed your child.
It is important to contact the child’s doctor about any of the following:
- Increasing pain or pain that is not relieved by medication
- Any drainage, bleeding, redness or swelling around the tube
- Vomiting, cramping, nausea or diarrhea
- Aspiration (breathing food bits into the airway)
- If the tube comes out or there is a blockage in the tube.