I Need a Feeding Tube — But Now What?: Iris’s Guide to PEG Tubes

What is a PEG tube? 

A percutaneous endoscopic gastrostomy tube (PEG) is a feeding tube that allows you to obtain nutritional needs through a tube in the stomach. A PEG tube placement is typically done as an outpatient surgical procedure.  

This flexible tube is inserted into the inner wall of the stomach, through a small incision, and held in place by a small water-filled balloon or a small wire that curls like a “pigtail.” The tube extends through the skin to the exterior of the body through the same incision used for placement. The balloon or pigtail prevents the tube from coming out of place. The length of the tube may vary based on the type of tube used by your surgeon.  

Does Every Patient Need a PEG Tube? 

PEG tubes are needed in specific situations to help patients maintain nutrition when they are unable to do so eating by mouth. This may be necessary before, during, or even after treatment. Your oncologist can discuss with you whether a PEG tube is necessary. 

Reasons for needing a PEG tube can include: 

  • Difficulty swallowing due to tumor size and/or location 

  • Radiation to the head, neck, and chest area 

  • Significant nausea and vomiting that is unable to be controlled 

  • In preparation for larger surgeries such as esophageal resections 

How do I manage my nutrition with a PEG tube? 

Depending on your situation, your oncologist may recommend that you continue to eat and/or drink by mouth while taking added nutrition through your PEG tube. Other instances may require that all your nutrition be taken through your tube. The formula needed for your tube feeding will be managed by your oncology team and nutritionists. Feeding through your PEG tube, also known as enteral nutrition, can occur in a few ways, which include: 

  • A continuous feeding using a pump. This will be set to a specific infusion rate. 

  • By gravity through a feeding bag that is hung on a pole or hook (like an IV pole) 

  • Individual feedings given several times a day using a 2-ounce syringe 

Patients receiving tube feedings need to sit upright during and 30-60 minutes after feedings. This is important to prevent the feeding formula from accidentally going into the lungs (aspiration).  

How do I care for my PEG tube? 

  • It is important for you and your caregivers to wash hands well before handling your PEG tube.  

  • Make sure to keep the skin around your tube insertion area clean, dry, and covered with gauze. 

  • Your surgeon may recommend wearing an abdominal binder or using surgical tape to secure the tube to your skin. This can help prevent accidental tugging on the tube, which can cause discomfort. 

  • Follow your clinical teams’ instructions on regularly flushing your tube with water. 

  • Once removed, most incisions from the PEG tube begin to heal within 24 hours.  

  • Troubleshooting difficulties with your PEG can include

    • Occasionally, stomach juices may leak onto the skin around the tube and cause redness or irritation. It is important to clean and dry the skin as soon as possible if this occurs. 

    • If you notice bleeding, drainage, redness, swelling, increased pain or foul smell from your incision site, contact your surgeon or oncologist for guidance.  

    • If your PEG tube comes out- contact your surgeon and/or oncologist immediately or go to your nearest emergency room. Typically, the inside incision begins to close quickly, so it is important to let your care provider know about this right away.  

    • If your PEG tube becomes clogged, try using warm water to flush the line. Firmly pull and push the plunger of the syringe to try to unclog the tube. Do not force the water into the tube. If you cannot unclog it, contact your care provider for further guidance. 

Things to remember 

  • In some cases, you may receive all your food and nutrition through the tube, it is still important to maintain good hygiene and moisture in your mouth during this time.  

  • The length of time that you will have your PEG tube varies widely and is decided by your specific needs.  

  • PEG tubes may need to be replaced in 6-12 months, which typically can be done in an office setting.  

  • Not all medications can be given through your PEG tube. Please make sure to discuss with your pharmacist how best to administer your medications.