Gastrostomy tube placement

About a gastrostomy tube

A gastrostomy tube is a thin, flexible tube that passes through the skin of your abdomen (tummy) into your stomach.

It allows us to:

• feed liquid food and water directly into your stomach
• give you medications directly into your stomach.

A gastrostomy tube does not stop you from eating and drinking. If we have said you can eat and drink, the tube will make no difference.

Why you need one

There are many reasons why you may need a gastrostomy tube.

Usually, patients who need one are unable to eat or drink enough (or cannot eat or drink at all). This means they cannot meet their body’s nutrition and hydration needs by mouth.

Sometimes we place one in advance because we know a particular treatment or illness is likely to cause you problems with eating and drinking.

We will not proceed with gastrostomy tube placement unless we have your written consent. If you are unable to provide consent, we will contact your next of kin.

If you decide you do not want a gastrostomy tube, we will respect your choice and support your decision.

Alternatives to a gastrostomy tube

If you decide you do not want a gastrostomy tube, there may be another option. This will depend on your medical condition and the reasons why we recommend tube feeding for you.

Ask your doctor to discuss other options with you.

You may decide that you do not wish to be tube fed. If this is your choice, we will support you. It is important that you discuss this fully with your doctor and medical team, so you are clear about what it means for you.

Types of tube insertion

There are two common ways of inserting gastrostomy tubes, but they both have the same result. The different names describe the method of insertion.

• A Percutaneous Endoscopic Gastrostomy (PEG) uses an endoscope (a flexible tube that we pass into your stomach).
• A Radiologically Inserted Gastrostomy (RIG) uses x-ray guidance.

We will discuss with you the type of gastrostomy that we recommend for you. Talk to your medical team if you have questions.

Pain

Once the local anaesthetic has worn off, patients often feel some pain or discomfort around the tube site. This can last a few days.

We will prescribe painkillers for you which we recommend you take if you need them. We will give you some to take home if you need them.

If the pain is severe or does not go away, do the following:

• talk to your medical team if you are in hospital
• contact your GP if you are discharged home.

Preparing for the procedure

We usually insert the gastrostomy tube while you are in hospital.

We will give you a blood test a few days before the procedure.

A doctor will examine you and discuss the procedure with you. 

They will ask you to sign a consent form.

If you come come into hospital on the day we insert the tube, the doctor will see you when you arrive.

The procedure

You can expect the following during the procedure.

• We will give you an antibiotic through a small needle in the back of your hand or lower arm. 
• We will take you on your bed or hospital trolley to:
  • the Endoscopy Department for a PEG, or
  • the Radiology Department for a RIG
• A doctor will check your consent details.
• We will monitor your pulse and blood pressure.
• We may give you oxygen. 

PEG tube

• The procedure takes about 20 minutes.
• We will ask you to remove any false teeth and rinse your mouth out with an antiseptic mouthwash. This helps prevent infection following the procedure. If you are unable to do this yourself, we will help you.
• We will give you a local anaesthetic spray to the back of your throat. You may also require a mild sedative through a small needle in the back of your hand or in your lower arm. This will help you relax for the procedure.
• We will give you a mouth guard to protect your teeth and allow the endoscope to pass through your mouth smoothly.
• We will give you a local anaesthetic injection to numb the area on your stomach where we insert the tube.
• We will pass an endoscope through your mouth into the back of your throat and down into your stomach. An endoscope is a thin, flexible tube with a light and camera at one end. Using the endoscope, the doctor will be able to view the inside of your stomach and locate the ideal position for us to insert the PEG tube.
• We will make a small hole in the skin on your stomach and pass the PEG tube through it.

RIG tube

• The procedure takes about 40 minutes.
• We may need to give you a sedative.  Your doctor will discuss this with you.
• We will pass a small flexible tube (called a nasogastric tube) through your nose, into the back of your throat and down into your stomach. We will push air into your stomach through the nasogastric tube. We do this to fill your stomach and push it forward so the doctor can make a direct hole from your skin to the inside of your stomach.
• During the procedure, we will take X-rays to help the doctor see where to insert the RIG tube.
• Once the doctor has located a safe area to insert the RIG tube, we will give you a local anaesthetic to numb the area.
• The doctor will use 2 to 4 stitches in your stomach to ensure they can safely insert the RIG tube. We will make a small hole in the skin of your stomach and pass the RIG tube through it.

Immediately after the procedure

After the procedure is finished, if we have given you sedation, a member of your medical team will stay with you in the recovery area until the sedative has worn off.

We will then take you back to the ward.

Most patients have to wait a few hours before they can start using the tube. 

Your dietician will design an individual feeding plan for you and discuss this with you. They will see you regularly after your procedure.

Risks and complications

Gastrostomy insertion is considered to be generally very safe. We will discuss the possible complications with you.

The main complications following gastrostomy are the following.

• Infection. This can occur after we insert the feeding tube. It usually occurs around the wound site. We usually give the patient antibiotics before the procedure, and this greatly reduces the risk of infection.
• Bleeding. A small amount of bleeding from the wound site is normal. This will usually stop of its own accord. Let your medical team know if it does not stop. In a small number of cases (around 1 in 100) a patient may need to be taken to theatre for a procedure to stop the bleeding.
• Perforation (puncturing) of the bowel. This is a risk due to the nature of the procedure, but it is rare. It may not always be possible to diagnose this at the time of procedure, because abdominal pain or bloating happens later. We will discuss this with you before your procedure, when we ask for your written consent.
• Risks of sedation. Sedation may affect your breathing. For this reason, if you have a chest infection, your doctor may decide to postpone the gastrostomy placement until you have had a course of antibiotics, and your chest infection has cleared. We will monitor your breathing throughout the procedure.

Living with your tube

Using it

We will show you how to use the tube while you are in hospital. We will give you a booklet with detailed information.

Special liquid food, water and some drugs can be put down the tube using a large syringe, which connects directly to the tube.

Alternatively, you may be fed using a special pump, which gives the feed slowly over a longer period of time, for example overnight.

If you or your carer(s) are unable to set up the feed, we can usually arrange for a community nurse to visit you at home to do this for you.

You do not have to pay for the equipment or the feeds if you are an NHS patient or registered with a GP. You can arrange for the feed and equipment to be delivered to your home at a time that suits you.

Looking after it

Before we discharge you home, the nurse will check that you know how to look after your gastrostomy tube.

After discharge, your Nutricia Nurse and District Nurse will check your gastrostomy site regularly, at home.

If you are worried about your tube, contact your Nutricia Nurse, District Nurse, Community Dietitian or GP. We will let you know how to do this before we discharge you home.

Clothing

You can cover your tube with normal or loose clothing, but it will show under tight clothing. You may find it more comfortable to wear your waistband below your gastrostomy tube.

Washing/swimming

You can shower the day after we insert your tube.

If you take a bath, it must be shallow (do not fill the bath with a lot of water). Do not soak the wound site for at least 2 weeks, so that it can heal properly.

You can swim when the wound site has fully healed. Speak to your nurse, who can give you advice on how long it will take for your wound to heal.

Holidays

You can go on holiday when you have had a gastrostomy tube inserted. Your Nutricia Nurse can give you advice on travelling. Contact your Nutricia Homeward Coordinator for more information.

How long the tube stays in place

Your community dietician will visit you at home regularly to monitor your nutrition and fluids.

They will arrange for removal of your tube when when you are eating and drinking enough, and no longer need the tube to provide extra nutrition and fluids.

Some patients may need the tube permanently. Your medical team will discuss this with you.

We will respect your wishes if you decide that you want us to remove the tube at any time.

Removing or replacing your tube

Removal

We usually remove the tube in hospital. We can give you a sedative if you need one. We will discuss this with you.

Routine replacement

Some gastrostomy tubes require routine replacement. This usually applies to the balloon type of tube used in the RIG procedure.

Routine replacement usually takes place every 3 to 6 months, depending on the manufacturer's instructions. It is a pain-free procedure that takes a few minutes, and your Nutricia Nurse can do it for you at home.

Other types of gastrostomy tubes can be replaced at the bedside. Your medical team will give you more information.

Over time your gastrostomy tube may show signs of wear and tear. If this affects the function of the tube, we may need to replace it.

Contact your Nutricia Nurse or community dietitian if you need more information.

More information

The British Association for Parenteral and Enteral Nutrition (BAPEN)

Patients on Intravenous and Nasogastric Nutrition Therapy (PINNT)

Nutricia