This leaflet is to provide you with guidance and information to help support your decision regarding a feeding tube being placed into the stomach.
You probably have several questions you would like answering before deciding whether to have one.
What is tube feeding and why is it used?
Tube feeding is a method of providing nutrition to people who cannot obtain enough calories by eating or those who cannot eat because they have a swallowing difficulty. Tube feeding is used to make sure that you receive enough nutrients when you are unable to eat sufficient amounts of food to maintain your weight. It can also be used to give adequate water and, or medications.
What are the benefits to me?
Tube feeding can provide you with good nutrition, which can improve your sense of wellbeing, reduce fatigue, help your body fight infection, may help prevent weight loss and promote weight gain if appropriate. Tube feeding can reduce any anxiety related to being unable to eat well throughout the day and may improve general quality of life.
Although tube feeding does not give the same pleasure as eating it can relieve feelings of hunger or thirst.
How is the tube used to feed me?
The dietitian will recommend a specially prepared liquid feed which contains all the nutrients you need in a day, for example, calories, protein, fat, vitamins, minerals, fibre and fluids. This feed can be administered in 2 different ways:
- By bolus method
The liquid feed is fed into the tube by a syringe. - By an electric pump
The rate of the feed is controlled by this pump.
Your dietitian will discuss with you the most suitable way for you and your lifestyle.
There is also the option of giving blended diet (blended home foods and fluids) via your tube, using the bolus feeding method only.
What this would involve, including the advantages and possible risks can be discussed with your Dietitian and managing Consultant. A shared decision-making agreement would need to be discussed and completed before starting.
What feeding equipment will I require?
Depending on how the feed is to be given you may require:
- Electric feeding pump
- Syringes
- Connecting tubes (called giving sets)
You will be shown and taught how to use the equipment before you leave hospital. You will receive monthly supplies of liquid feed, syringes and giving sets (if required) delivered to your home.
Will I still be able to eat and drink?
If you have swallowing problems your Speech and Language Therapist (SALT) will advise you whether it is safe to take anything by mouth and together with the Dietitian will advise what types of food and drinks are suitable.
If your ability to eat and drink is likely to be affected by the side-effects of treatment you are receiving, you may not see a Speech and Language Therapist. Therefore, the decisions around how much you are able to eat and drink by mouth and how much nutrition and fluid you need to put down your feeding tube will be discussed with your Dietitian.
How will I take my medication?
If you can eat and drink and this is safe to do so, you may be able to swallow your medication. If this is not possible, medications will be prescribed as a liquid.
If they are unavailable in liquid form, tablets can usually be crushed or dissolved in warm water and administered down the tube with a syringe. Having the feeding tube can often make it easier to make sure you receive all your medication.
Will I be able to bath, shower or swim?
The area around where your tube has been inserted can take 4 weeks to mature and therefore should not be immersed in water. A shallow bath (water below the tube site) or a shower may be taken after 2 days.
Once the area round the tube has healed and matured, you can have a full bath (water can come above the tube site), a shower and go swimming.
Who looks after the tube?
It is important to consider this before the tube is placed. Giving feed, medications and water through the tube and care of the tube requires daily attention.
Some individuals manage to do these themselves while others need support from relatives, carers and healthcare professionals. Training will be provided to all that need it on how to care for your tube and how to give bolus/pump feeds and medications via your tube before being discharged home.
How long will I need to stay in hospital?
You will need to stay in hospital for at least 1 night. However, depending on individual circumstances you may need to stay in hospital longer than this to ensure your discharge home is safe.
How is the tube inserted?
You will attend the Endoscopy department and have a tube placed by one of three possible techniques:
- Pull PEG (Percutaneous Endoscopic Gastrostomy)
- Direct puncture (push) PEG
- TNE (trans-nasal endoscope) direct puncture PEG
Pull PEG (Percutaneous Endoscopic Gastrostomy)
The tube is inserted during a minor procedure in hospital and is usually under a local anaesthetic or a light sedative (medication that makes you drowsy) or both.
- An endoscope, a flexible instrument about the width of a small finger, used to examine inside the stomach, is passed through your mouth, throat and into the stomach. Some air will be passed through this instrument to expand the stomach and allow the doctor a clear view. A suitable point somewhere between your tummy button and rib cage will be chosen to place the feeding tube. This chosen area is numbed and a small incision is made into your stomach.
- A guide wire is inserted into the incision from the outside.
- The guide wire is brought up from your stomach and out of your mouth using the endoscope and then the feeding tube is attached to it. It is then pulled back through the mouth down into the stomach and through the incision.
The whole process takes about 30 minutes to complete and you will be drowsy whilst it is happening.
If there is any discomfort after the procedure you will be given pain relief to help.
Direct Puncture (Push) PEG
This procedure, known as a direct puncture or “push” procedure is required for patients having treatment for head and neck tumours, or other conditions where a pull PEG technique cannot be performed.
An endoscope is used under sedation and passed through your mouth, throat and into the stomach. A suitable point somewhere between your abdomen button and rib cage will be chosen to place the feeding tube.
The area where the tube is to be inserted is numbed with local anaesthetic, an incision is made and the PEG tube is inserted through the stomach wall rather than being pulled though the mouth. Two stitches are placed through the stomach wall and the PEG tube is then inserted directly.
A balloon is inflated with water to keep it in place and this water volume needs to be checked and replaced weekly.
This procedure can take around 40 minutes. The stitches will need removal usually 7 days later.
TNE (trans-nasal endoscope) Direct Puncture PEG
In certain circumstances the procedure mentioned above may be performed using a trans-nasal endoscope (TNE) with or without sedation. This is an ultra-thin endoscope designed to be inserted via one nostril rather than the mouth. You will be sat upright and nasal spray is given to numb the nostril.
This technique has some advantages for some patients, particularly those who cannot have sedation or are unable to lie flat.
What are the risks of the procedure?
This is a low risk procedure however with any treatment there are risks and benefits. Below are some of the possible risks:
- Sedatives can affect your breathing but using light sedation can reduce these risks. Occasionally a chest infection may occur. If you are deemed to be at high risk from receiving sedatives, the team might decide for you to have a trans-nasal endoscopic approach (see previous page).
While inserting the endoscope or the feeding tube there is a small risk of:
- Internal bleeding. This normally settles on its own however it may need further intervention.
- Puncturing of the bowel or liver and, or leakage of stomach contents (known as peritonitis). This is rare but can be serious. A hospital admission and sometimes an emergency operation is required.
- There may be a slight risk to crowned teeth or dental bridgework during the passage of the endoscope.
- Antibiotics are given on the day of the procedure before the feeding tube is inserted to reduce the risk of an infection. There is still the chance that an infection may occur where the tube passes through the skin and further antibiotics may be needed.
- You may have a sore throat for the rest of the day after the feeding tube is inserted.
- You may feel a little bloated after the feeding tube is inserted caused by some air remaining in your stomach.
- You may suffer some discomfort around the area where the feeding tube has been inserted. If this occurs, you will be given pain relief to help.
- There is the risk that the procedure may not be successful. We may not be able to pass the endoscope into the stomach or may not find a suitable, safe site in the stomach for the PEG.
How long will I need to have the tube?
This really depends on the individual. If you need the tube for a long time you may need to have it replaced. There are a variety of tubes available.
A pull PEG feeding tube can last for one to two years. A direct puncture (push) PEG feeding tube is generally changed every four to six months, or earlier. A replacement tube can normally be changed at an outpatient appointment.
Replacement tubes
There are a variety of replacement feeding tubes.
There may be an option to change your feeding tube to one of these tubes if you wish.
For further advice about whether this is appropriate for you please discuss with your Specialist Nurse or Dietitian.
How will it affect my life?
A tube feed may change your routine and may mean you have to consider different things. It may take time to adjust to these changes.
Making the decision
It is your decision as to whether you want a feeding tube and sometimes this can be a difficult decision to make. You may find that the decision also affects your relatives and carers. Discussing this together will hopefully bring you to a shared understanding.
After reading this leaflet you may still have some questions and may wish to discuss certain aspects in more detail.
So, what happens next?
If you decide you want to have a PEG placed and you are considered well enough to have the procedure a referral will be sent to the Specialist PEG Nurse or Gastroenterology Consultant who will arrange a face-to-face outpatient appointment to see you, your family or carers to discuss the procedure in greater detail.
After this discussion if you wish to have the feeding tube inserted you will be asked to sign a consent form, a sample of your blood will be taken and a date to have the feeding tube placed will be organised.
You must attend this appointment before a PEG date can be arranged.
Contact us
If you require further information, please contact us on:
- Dietetics and Nutrition Dept – James Cook University, Middlesbrough, TS4 3BW
Telephone: 01642 854777 or Email: [email protected] - Community Dietetics – Langbaurgh House, Guisborough, TS14 7AA
Telephone: 01642 944 455 or Email: [email protected] - Dietetics and Nutrition Dept – Friarage Hospital, Northallerton, DL6 1JG
Telephone: 01609 762012 or Email: [email protected]
Patient experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.
T: 01642 835964
E: [email protected]