What is a gastrostomy tube?
A gastrostomy tube (also called a PEG or G-Tube) is simply a tube that has been placed through the skin into the stomach. It can be used for feeding and administration of medications.
Why do I need a gastrostomy tube?
G-Tubes are placed for several reasons. Some people cannot swallow (temporarily or permanently) so the G-Tube is a way to get nutrition into the stomach. Reasons that people cannot swallow include (but are not limited to) stroke, obstruction in the mouth, throat, or esophagus, and inflammation due to radiation. Some people are just not able to take in enough calories to meet their needs. On occasion a G-Tube is placed to allow air and fluid to escape when there is a blockage beyond the stomach (venting G-Tube).
What are the risks?
G-Tube placement is a relatively safe and low risk procedure. The two main complications seen are bleeding and infection at the insertion site. In order to reduce the risk of bleeding, it is recommended to not use the G-Tube for feeding for at least 24 hours after placement. This way the stomach isn’t expanding is allowed time to heal.
How is a G-Tube placed?
Gastrostomy tubes may be placed endoscopically, surgically, or radiologically. The choice of procedure will depend on anatomic considerations that may affect the ability to place the tube endoscopically or radiologically (eg, inability to endoscopically identify an appropriate placement site because of prior surgery or obesity), and whether the patient is undergoing surgery for other reasons. We place our G-Tubes radiologically using fluoroscopic (X-ray) guidance.
Your procedure will be done at El Camino Hospital where you will be set up with an IV to allow access for moderate, also known as “twilight” sedation. You will then be taken to the procedure room where you will have a team of two nurses, a radiology technician and your interventional radiologist. You will be connected to heart, blood pressure and oxygen monitors during the entire procedure. IV medication will be administered to make you comfortable (moderate sedation). A tube will be inserted through your nose (nasogastric tube) and maneuvered to your stomach with fluoroscopic guidance. Through this tube, the stomach is filled with a small amount of air to better visualize the stomach anatomy. A site on the skin is cleaned and sterilized and local anesthetic is injected in this area to numb the site. Small buttons called “T-fasteners” are then placed on the skin and into the stomach. These help bring the stomach wall close to the abdominal wall. At this point, the stomach is affixed to the anterior abdominal wall (gastropexy).
Between the T-fasteners a needle is inserted into the stomach, and air is aspirated to confirm placement. A guidewire is passed through the needle, the needle is removed, and a G-Tube is placed over the guidewire and advanced into the stomach. A dye is injected to confirm correct tube placement, and an external bolster is placed on the tubing to keep it securely in place at the skin. A retention balloon at the end of the G-Tube inside the stomach is inflated with fluid, which prevents the G-Tube from being pulled out. Nasogastric tube tube is then removed.
What can I expect after the procedure?
You will recover after your procedure for about 1 hour where your procedure site, heart rate, blood pressure, and oxygen will be monitored. Your family will be able to see you soon after the procedure in the post-operative area. You should expect to have some abdominal pain and tenderness at the G-Tube site for the next 2-3 days. G-Tube should not be used for at least 24 hours after placement. You should try to have only a clear liquid diet for the rest of the day of the procedure to help your procedure site heal and reduce any risk of bleeding and leaking. By the next morning if you do not have significant abdominal pain you can slowly progress your diet to a soft and pureed diet and eventually to your regular diet.
If you cannot eat or drink then you can start using your G-Tube the day after the procedure for feeding if you do not have significant abdominal pain.
How does the G-Tube stay in place?
There is an inflated balloon at the tip of the G-Tube that is filled with water. It is much larger than the tract through which the tube enters the stomach. That balloon prevents the tube from falling out.
Meanwhile, there is a flange on the G-Tube. It is on the outside, and you can see it close to the skin. This flange is meant to be advanced toward the skin and it maintains some traction on the balloon (inside of you) so that there won’t be any leakage of fluid from the stomach along the tube tract. It also prevents the balloon from sliding from the stomach into the intestine where it can cause obstruction. The G-Tube should be gently retracted while the flange is retracted so that the tube is snug.
What about those little buttons near the G-Tube entry site?
Those buttons called T-fasteners (2-4 of them) are temporary, and were placed as part of the procedure. They will fall off on their own in 1-4 weeks. Throw them away! Do not try to replace them and definitely do not go to the ER or try to schedule an appointment if they fall off. They are supposed to fall off! If they do not fall off after 2 weeks, schedule a follow-up to have them removed.
How do I care for the G-Tube site?
It is ok to get wet during the shower and it is helpful to clean the site with soap and water. After the shower, it is important to keep the site dry. In the days after the procedure, we recommend changing the dressing daily. After a few days, if the site stays clear without discharge it is often better to keep the site exposed without a dressing. It does not increase the risk of infection. Do not use ointments as they may cause the tube to slip. Check the skin daily for signs of infection and irritation. If it gets red and painful it could require oral antibiotics.
Periodically check your G-Tube site throughout the day to ensure that the flange is tightly snug to your skin. This will help prevent leakage around your tube. If it is loose, don’t be afraid to gently pull on the tube and slide the flange down towards your skin. If your skin is moist, make sure to clean it with hydrogen peroxide and water and pad dry it. You want to prevent moisture as much as possible to reduce the risk of skin irritation and infection.
Flushing: you should flush the tube daily. You can fill a syringe with tap or drinking water. Connect the syringe to the tube and flush with firm and steady pressure. Do not force the syringe if flushing the tube is difficult.
Post-procedure general information:
Most patients will get sedation during the procedure. It is a moderate sedation also known as “twilight” sedation given through IV. That means you will be awake during the procedure, but hopefully will be comfortable and most of the time won’t be able to remember. If you received sedation, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.
You may resume your regular activities (including driving) after 24 hour, unless you have been restricted for another reason.
No exercising, lifting heavy objects or strenuous activity for the next week.
You may use over the counter medication such as Acetaminophen (Tylenol) or Ibuprofen (Advil/Motrin) for minor discomfort, unless you are restricted from taking these medications.
If you feel that Acetaminophen (Tylenol) or Ibuprofen (Advil/Motrin) are not enough for pain control, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.
While this is controversial, no one really has a good reason why you cannot shower with your G-Tube. So although we suggest that you do NOT shower the day of the procedure, you can shower the next day. During this time you should not soak the catheter or the insertion site in water (eg. bath and swimming pool).
If the dressing gets wet during shower, dry the area around the catheter and apply a new dressing.
What should I watch for?
You may be sore after the procedure, but this should not get worse and should subside within a few days. Another common occurrence is a small amount of discharge around the tube.
However, these are the things you should watch for:
Increased abdominal pain or abdominal distention
Redness or increased tenderness at the G-Tube insertion site
Fluid or pus leaking around the catheter insertion site
If you have any of the above you should contact our team (650-404-8445) or you can send us a message through My Health Online (MHO).
What if I have questions about using my G-Tube?
You can call the Interventional Radiology Clinic M-F from 8am till 5pm if you have questions. An appointment will be made to review the use of the G-Tube and give you any additional information. We are sure you will have more questions that can be answered at the time of the appointment.
You can reach your Interventional radiologist at 650-404-8445 during M-F 8-5pm, or the physician can be reached through the operator after hours or on weekends by calling 408-739-6000 and asking for the Interventional Radiologist “on call.”