Synapse - reconnecting lives

A brain injury can result in the muscles for chewing and swallowing becoming weak, slow and or uncoordinated.

A Percutaneous Endoscopic Gastrostomy (PEG) feeding tube can improve a person's nutritional intake and contribute to a greater quality of life where there are severe swallowing difficulties, which can lead to:

• food and water entering the lungs and causing chest infections
• eating less and inadequate nutrition. 

A PEG tube passes directly into the abdominal wall so nutrition can be provided without chewing or swallowing. A dietitian will prescribe a suitable liquid formula containing protein, fat, carbohydrate, fluid, vitamins and minerals. There are three main ways that the liquid feed can be administered:

• bolus method where liquid is poured down a syringe into the tube
• a bag of liquid food is hung from a stand and drips through the tube
• an electric pump. 

How PEG tubes are inserted

Insertion of the tube involves a minor surgical procedure which takes about 30 minutes under a mild sedative or general anesthetic.

An endoscope is used to examine the inside of the stomach. After the area has been anesthetized, a small incision is made through the abdominal wall. A guide wire is inserted into the incision and brought up through the endoscope into the stomach with the feeding tube attached. The tube is prevented from moving by a small plastic disc internally and a flange externally. A cap is placed over the end of the tube when feeding is not taking place.

Is accidental removal of the tube dangerous?

 A common misconception when first learning about PEG feeding is that if a person accidentally or deliberately pulls a feeding tube out this can be life threatening for a person. This is not life-threatening, but the tube does need to be correctly reinserted by a trained person.

Common problems & solutions

The most common problems are blocked feeding tubes, exit site infection, deteriorated tubes, incorrect feeding formula or gastrostomy tubes that have been inadvertently removed. 

Infection of the tube exit site can be avoided by washing the site with warm water and soap and cleaning around the external bumper with a cotton bud, ensuring that the area is also dried thoroughly. After each feed, the tube should be flushed with cooled, boiled water to avoid tube blockages.

The tube should be checked each day and any changes in the appearance of the exit site e.g. redness, itchiness or presence of discharge or the tube itself. Cracking or leakages should be reported to the referring doctor immediately. A feeding tube will generally last between one to two years and can be easily replaced without hospital admission.

Best feeding position & formula

A person should never be positioned laying down flat. They should lie with their head at a 30° angle or sitting upright in a chair, remaining in this position for approximately 30 to 60 minutes afterwards.

Some people may not tolerate a certain feeding formula. Adverse reactions to the type of feeding formula can include nausea and diarrhea. If you begin to experience these symptoms contact your prescribing specialist as some experimentation may be required before finding the type of formula and quantity that best meets the individual's needs.