What is a PEG Tube? PEG Tube Insertion and Care (Home Care Guide)

A PEG tube (Percutaneous Endoscopic Gastrostomy) is an endoscopic feeding tube inserted through the abdominal wall to provide direct nutrition to the stomach in people who cannot receive adequate and safe nutrition by mouth. It is especially common in children with dysphagia, neurological diseases, long-term enteral nutrition needs or children who need growth and development support. The most common questions that families are most curious about are “What is **PEG?”, “How is PEG tube insertion done?”, “How is PEG care done at home?” and “What should I do if the tube gets blocked or dislodged?”.

In this article, we will explain what a PEG tube is for, who it is recommended for, the procedure process, PEG feeding and PEG medication practices, the daily care routine and safe steps to be taken in case of common problems (such as PEG tube blockage, leakage, redness, granulation tissue). We will also include small but effective tips to make life with PEG easier for children. (Note: This content is for informational purposes; for personal medical decisions, please consult your physician and dietitian)

What is a PEG Tube (Percutaneous Endoscopic Gastrostomy) and What Does It Do?

A PEG tube is a feeding tube that reaches the stomach. the term “feeding tube” is sometimes confused with nasogastric catheter (NG catheter). the NG catheter extends from the nose to the stomach and is usually preferred for short-term use. PEG gastrostomy is frequently considered for comfort and ease of use in the need for longer-term enteral nutrition.

What is a PEG tube for?

• **Supports adequate calorie and fluid intake (especially important in children at risk of weight loss and growth retardation).
• It can help reduce the risk of aspiration (food getting into the windpipe) in people with swallowing difficulties. However, it does not completely “eliminate” aspiration; correct positioning and feeding plan are required.
• it can facilitate the safe administration of medications (medication administration with PEG depends on specific rules).
• It facilitates home care management when it establishes a regular routine for family and caregivers.

Who gets a PEG tube?

• Dysphagia due to neurological conditions (e.g. cerebral palsy, neuromuscular diseases)
• Long-term inadequate oral nutrition
• Need for growth support in some metabolic/hereditary diseases
• Conditions in which long-term enteral nutrition is planned

Who may not be suitable?
In some cases, the decision for PEG is more carefully considered (e.g. severe clotting disorder, intra-abdominal infection, significant ascites accumulation). Therefore, it is not a “one-size-fits-all” solution; physician assessment is essential. Alternatives may include NG catheter, variants of gastrostomy or PEJ (jejunostomy).

How is PEG Tube Insertion Performed (Before, During and After the Procedure)

PEG tube insertion is a procedure usually performed under endoscopy. In most centers, it is performed with sedation or appropriate anesthesia. The most important thing that reduces the anxiety of families is to know the process step by step and to clarify expectations after the procedure.

Preparation before the procedure

• The physician assesses the general condition of the child/person, nutritional needs and risks.
• Usually a certain period of starvation is requested (your doctor will specify the duration).
• If blood thinners or certain medications are involved, the decision to cut/adjust is made by the physician.
• The family is educated about PEG care, nutrition plan and possible complications. If possible, the dietitian and the relevant therapy team (swallowing therapy, etc.) are also involved at this stage.

What happens during the procedure?

• The stomach is visualized from the inside with an endoscope.
• The appropriate point on the abdominal wall is identified and the tube is inserted into the stomach.
• Although the duration of the procedure varies according to the patient, it is usually short; the most important part is the post-procedure follow-up and training.

First days after the procedure

• There may be mild pain, tenderness and surrounding redness in the first 24-72 hours; however, it is expected to decrease gradually.
• When to start feeding (usually within a short period of time) and at what rate/volume is determined according to the clinical protocol.
• The family should be told clearly what is “normal” and what “requires urgent evaluation”.

Tip: The most difficult issue for caregivers in the post-procedure period is the question “Do I need a dressing?”. Since the area around the PEG may be more sensitive in the first days, some teams may recommend a short-term dressing; afterwards, regular skin cleansing is sufficient for most children. This decision depends on the condition of the stoma (tube entry site).

PEG Care: Daily Routine, Cleaning, Dressing and Bathing

Home PEG care, when managed with a regular checklist, both reduces the risk of infection and prolongs the life of the tube. The following recommendations are for general information; prioritize the training notes for your own center.

Daily PEG care routine (practical checklist)

1. Wash your hands: (The simplest but most effective step.)
2. Check the skin: Is there redness, swelling, discharge, bad odor, increased sensitivity?
3. Cleaning: Usually warm water and gentle cleansing is sufficient. Harsh antiseptics or perfumed products can irritate the skin.
4. Drying: Gently pat the area dry. Moisture may increase irritation.
5. Tube fixation: Make sure the tube is not curled or tugged. Soft fixation solutions work well for children with clothing friction.
6. Rotation: In some PEG types, daily/weekly rotation of the tube may be recommended, in others it is not. Therefore, there is no “one size fits all” rule; follow the instructions of your healthcare team according to your tube type.

Is a PEG dressing necessary?

• Short-term dressing may be recommended in the first few days or if there is discharge.
• If the stoma is dry and healthy, constant dressing can sometimes be unnecessary and increase moisture.
  Best practice: Individualize the dressing plan with your nurse/physician for children with a tendency to rash/rash.

Bath, sea, pool

“When is the bath after PEG placement?” is a very common question. Generally, bathing is more comfortable after the stoma healing process is complete; however, the timing varies from person to person.

• Prolonged exposure to water may not be recommended in the initial period.
• Always get your doctor’s approval for the sea/pool in terms of infection risk.

Linked to this section, swallowing and diet are also important. If you are interested, you can take a look at the following content: What is enteral nutrition? and Swallowing therapy in children (dysphagia).

Feeding with PEG and Administering Medication with PEG: Safe Practice Tips

PEG nutrition plan is organized by the dietician according to calorie, protein and fluid needs. The most critical goals in home practice are: correct speed/volume, correct position and the habit of “flushing” (washing with water) to prevent tube blockage.

Bolus or pump?

• Bolus feeding: Shorter feeding at regular intervals with a syringe or set. Practical for some children, but may cause vomiting/discomfort if given too quickly.
• Enteral feeding pump: Giving it more slowly and in a controlled way may be more appropriate in children with reflux, vomiting or tolerance problems.

The appropriate method is determined by reflux, aspiration risk, daily routine and tolerance.

Correct position (to reduce the risk of aspiration)

• A head-torso elevated position during and for some time after feeding is generally recommended.
• If lying down feeding is required (especially with a pump), position and speed adjustment become even more critical. Our article symptoms and prevention of aspiration can help you with this.

Why is flushing important?

PEG tube clogging is one of the most common household problems. To reduce blockage:

• flush with the amount of water recommended by the doctor before and after feeding and before/after medication.
• Products with too thick consistency or medicines that do not dissolve well can increase the risk of blockages.

Drug administration with PEG (most common mistakes)

• Not every tablet is crushed and given through the tube. Some medicines may be extended release or may be inconvenient to crush.
• Mixing medicines and giving them all at once may increase the risk of blockage and interactions.
• General approach: Giving medicines one by one, washing them with water in between and having the pharmacist/physician verify “can it be crushed?”.

Common Problems (Blockage, Leakage, Redness) and When to Apply to the Emergency Room?

Most families who use PEG face similar problems over time. The important thing is to know the line between “safe steps at home” and “medical evaluation required”.

The PEG tube is clogged: What should I do at home?

• First check that the tube is not kinked.
• Try gently flushing with warm water as recommended by your healthcare team.
• Never try to open it with a sharp object.
• If it won’t open or you have to force it, stop and seek medical attention. (Some centers may use special protocols such as enzymes/bicarbonate; do not do this randomly at home)

PEG leak: What causes it?

Leakage may be associated with conditions that increase pressure, such as incompliance around the tube, skin irritation, infection, rapid feeding or constipation.

• It is important to keep the skin dry and reduce irritation.
• If the leakage increases, is accompanied by an odor or discharge, or if the child experiences pain, an evaluation is needed.

Redness around the PEG and signs of infection

• Mild redness can sometimes be caused by friction/irritation.
• However, findings such as heat increase, swelling, yellow-green discharge, foul odor, fever raise suspicion of infection and require consultation with a physician.

Granulation tissue (flesh-like swelling around the PEG)

Granulation tissue may be common around the stoma and may be prone to bleeding. Treatment may sometimes require barrier creams, applications such as silver nitrate or different care plans. Do not try to pluck/wing it at home.

PEG dislodged: Time could be critical

the question “**What to do if the peg is dislodged?” may be an emergency because the stoma canal may narrow.

• If the tube has come out, immediately call your healthcare team or go to the emergency room.
• If you have not been taught beforehand, do not try to reinstall it yourself at home.

When to consult a doctor/urgent care?

Do not delay in the following cases:

• Suspected dislodgement or displacement of the PEG
• Severe/increased abdominal pain, hard abdomen, recurrent vomiting
• Fever, rapidly increasing redness, purulent discharge, foul odor
• Bleeding (non-stop/recurrent)
• Significant cough, bruising, shortness of breath during feeding (suspicion of aspiration)

Multidisciplinary support is important for nutrition safety and return to oral feeding in children. Related content: Nutrition therapy in children and Sensory nutrition problems.

Short FAQ

• **How long the PEG tube stays in place depends on the need and tube type; the replacement plan is determined by your physician.
• **Is pain normal after PEG insertion? There may be mild pain/sensitivity in the first days; if there is increasing pain or fever, evaluation is required.
• **In some children, safe attempts can be made with the guidance of the therapist and physician; the risk of aspiration must be evaluated.

Medical warning: This article is for general information purposes. PEG care and nutrition plan are individualized; the recommendations of your own follow-up team take precedence.