All about only for learning.

1. Our Moto,To get knowledge about:-
P E G ?
I n d i c a t i o n s .
C o m p l i c a t i o n .
M a j o r c o m p l i c a t i o n .
N u r s i n g m a n a g e m e n t .
F e e d i n g t h r o u g h G - t u b e a n d i t s t y p e s .
M a n a g e m e n t a f t e r i n s e r t i o n .
B e n e f i t s o f P E G f e e g i n g .

2. What is a Gastrostomy Tube (G-tube)?
A Gastrostomy Tube (G-tube) is either a tube or button (skin-level
device) placed into the stomach through the abdominal (belly) wall.
This is usually done during the same operation as a Nissen
fundoplication if the child also has reflux. A gastrostomy tube is
needed when the child cannot take enough nutrition by mouth for
proper growth and development, and also to “burp” a baby who has
had an anti-reflux procedure (Nissen Fundoplication). The type of
tube used will depend on the size and needs of the child. The
Percutaneous endoscopic gastrostomy (PEG) feeding tubes were first
described in 1980. PEG feeding tubes are increasingly used for long
term Enteral nutrition.

3. 1.Feeding.
2.Medicine.
3.Diagnostic purpose.
4.It is used where patients cannot
maintain adequate nutrition with
oral intake.
5.

8.  Feeding through a G-tube
There are many ways to feed through a
gastrostomy tube. A feeding plan that meets the
child’s needs will be created. The two most
common types of feedings are:
 Bolus: a specific amount of formula is given at a
set time. The formula runs in the tube by
gravity. For example, 10ml every 3 hours.
 Continuous/Pump: Formula is given over an
extended amount of time by using a pump. For
example, 5ml per hour for 24 hours.

12.  What is a PEG tube?
Another type of gastrostomy tube is the
Percutaneous Endoscopic Gastrostomy tube, or
PEG tube. This means the tube is placed with
the help of a scope. In the operating room, the
scope is passed into the mouth and down to the
stomach. A small opening is made in the
stomach and a tube is placed. No other cuts are
made. This procedure is usually for children
who do not need an anti-reflux procedure.

13.  Benefits of PEG feeding
 Benefits reported include:
 Well tolerated (better than nasogastric tubes)
 Improved nutritional status
 Ease of usage over other methods (nasogastric or oral
feeding) reported by carers
 Satisfactory use by home carers35
 Low incidence of complications
 Reduction in aspiration pneumonia associated with
swallowing disorders36
 Cost effective relative to alternative methods
particularly when reasonably long survival expected37

14.  Management after insertion
 Education of carers and patients is essential to
reduce tube problems and complications.38
 A number of studies indicate the support and
education of patients should be
multidisciplinary involving:
 Nurses (wound care and ostomy expertise).
 Dietitians (nutritional advice and support).
 Ongoing care involves:

15.  Care of PEG tube
 This routine care can be performed by the patient and/or the carers
with suitable training. After about 10 days following insertion
asepsis is not required.
 Examine skin around site for infection/ irritation.
 Note measuring guide number at end of external fixation device.
 Remove tube from fixation device and ease away from abdomen.
 Clean stoma site with sterile saline.
 Dry area with gauze.
 Rotate gastrostomy tube to prevent adherence to sides of track.
 Re-attach external fixation device to abdomen.
 Attach gastrostomy tube gently to fixation device and position as
before according to mark/number on tube.
 Avoid use of bulky dressings.

16.  Complications
 Morbidity and mortality are generally considered to
be low with studies reporting major complications
between 3% and 8% of patients and minor in
around 14%.14,39 Mortality from the procedure itself
is very low and less than 1%.40 However other
studies report higher and rising complication
rates.3 These often relate to the underlying illnesses
with for example higher rates of wound infections
in malignant disease and may also reflect a lowered
threshold for PEG insertion.3
 gastric or abdominal wall).

17.  Major complications
 Gastric perforation
 Gastrocolic fistula
 Internal leakage.
 Dehiscence.
 Peritonitis.
 Aspiration pneumonia
 Subcutaneous abscess
 Buried bumper syndrome (migration of the internal
bumper of the PEG tube into the gastric or
abdominal wall).

18. Thanks for coming
Abdul Fattah R.N, NICU Aga Khan University
Uospital