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Thread: Peg procedure

  1. #1
    Forum Member Jeannie's Avatar
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    Thumbs up Peg procedure

    For people considering having a PEG fitted
    Definition

    A surgical procedure to place a tube inside of the stomach. This procedure is a less invasive alternative to an open abdominal operation (laparotomy).

    Parts of the Body Involved
    Stomach, skin, parts of the abdominal wall

    Reasons for Procedure
    A gastrostomy tube is used to:

    Feed a person who has difficulty sucking or swallowing for up to 14 days or longer
    Drain the stomach of accumulated acid and fluids in a person with a blockage between the stomach and the small intestine


    Risk Factors for Complications During the Procedure
    Stress
    Obesity
    Smoking
    Excess consumption of alcohol
    Use of narcotics or other mind-altering drugs
    Use of certain prescription medications, including muscle relaxants and sedatives, anti-hypertensives, insulin, beta-adrenergic blockers, cortisone
    Prior surgeries that involved or may have made positioning the abdomen difficult (such as a gastrectomy)
    What to Expect
    Prior to Procedure

    Your doctor will likely do the following:

    Physical exam
    Medical history
    Review of medications
    Blood test
    Urine test
    X-rays of gastrointestinal tract
    Endoscopic examination of stomach - an endoscope is a fiberoptic tube attached to a viewing device


    In the days leading up to your procedure:

    Do not take aspirin, aspirin-containing products, or anti-inflammatory drugs for one week before the procedure after discussing this with your
    Do not eat or drink for at least eight hours before the procedure
    Arrange for a ride to and from the procedure


    Just before the procedure:

    You'll remove eyeglasses and dentures
    You'll remove your clothes and put on a hospital gown


    During Procedure:

    IV medications
    Sedative
    Anesthesia
    An endoscope will be inserted into your stomach through your mouth


    Anesthesia - Local, usually a lidocaine spray; IV pain reliever and a sedative

    Description of the Procedure - This procedure is usually done by a surgeon and a gastroenterologist working together. An endoscope (a long, thin fiberoptic tube with a tiny video camera on its end) is inserted through the mouth and down the esophagus into the stomach. The endoscopic camera is used to produce pictures of the inside of the stomach on a video monitor so that the proper spot for insertion of the PEG feeding tube can be located.

    The surgeon inserts a needle into the stomach at the spot where the PEG tube will be located. Using the endoscope, the gastroenterologist locates the end of the needle inside the body, and encircles it with a wire snare. A thin wire is then passed from the outside of the body, through this needle and into the abdomen. This wire is then grasped with the snare and pulled out through the mouth. Now, there is a thin wire entering the front of the abdomen into the stomach and continuing upward and out the mouth. The PEG feeding tube is attached to this wire outside of the mouth. The surgeon then pulls the wire back out from the abdomen, which pulls the PEG down into the body through the mouth and esophagus. The tube is pulled until the tip of the PEG comes out of the incision in the stomach. There is a soft, round "bumper" attached to the portion of the PEG that remains inside the body, this bumper secures the tube on the inside of the body. The outer portion of the tube is secured with a bumper as well. Sterile gauze is placed around the incision site.



    Percutaneous Endoscopic Gastrostomy Procedure





    Copyright 2005 Nucleus Communications, Inc. All rights reserved. http://www.nucleusinc.com/



    After Procedure - The PEG tube is secured to your abdomen with tape

    How Long Will It Take?

    30-45 minutes

    Will It Hurt?

    Anesthesia prevents pain during the procedure, although you may feel some discomfort. For a couple of days after the procedure, you may have minor pain and soreness at the incision site, which often feels like a pulled muscle. Your doctor can prescribe pain medications to relieve this discomfort.

    Possible Complications:

    PEG complications are relatively rare. Complications include:

    Wound infection
    PEG tube dislodgment or malfunction
    Aspiration - accidental sucking into the airways of fluid, food, or any foreign material
    Bowel perforation - a hole in the wall of the intestine
    Gastrocolic fistula - an abnormal opening connecting the stomach and the colon
    Peritonitis - inflammation of the lining of the abdomen
    Septicemia - an infection affecting the entire body, caused by the spread of microorganisms and their toxins through the circulating blood
    Leakage at the tube insertion site
    Abdominal bloating
    Nausea
    Diarrhea
    Irritation or infection of skin around the tube


    Average Hospital Stay: 0-1 day

    Postoperative Care:

    When resting in bed, keep legs elevated and moving to avoid deep vein blood clots
    Change the sterile gauze pads around the incision site regularly
    Learn to feed yourself properly through the PEG feeding tube:
    You'll receive fluids through an IV for a day or two, then you'll be advanced to clear liquids through the gastrostomy tube, and then to a formula
    A dietitian will teach you how to use your PEG tube and how to choose an appropriate tube-feeding formula
    Remain upright for 30-60 minutes after eating
    Do not smoke
    Learn the proper care of your PEG tube
    Wash PEG tube and skin around tube regularly to avoid infection
    Learn how to empty the stomach through the tube
    Learn how to recognize and handle such problems as a blocked tube or a tube that falls out of place
    Tape tube site when not in use to help prevent dislodging
    Do not take prescription pain medication for more than seven days. After this point, take non-prescription pain relievers (such as ibuprofen) as necessary, but avoid taking aspirin or aspirin-containing products
    To promote healing, resume normal activities as quickly as possible


    Outcome
    This procedure results in the placement of a workable alternative feeding site.

    Call Your Doctor If Any of the Following Occurs
    Signs of infection, including fever and chills
    Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
    Headaches, muscle aches, dizziness, fever, or general ill feeling
    Nausea, constipation, or abdominal swelling
    Vomiting
    http://www.aurorahealthcare.org/your...214852.html%22
    Best wishes

    Jeannie

    Please donate and share forever grateful xx Please see the link https://www.gofundme.com/83tq5j-help..._co_campmgmt_w
    ______________________________________
    ALS onset June 2000, dxed July 2001, I am 40 yrs old.
    Living and loving everyday regardless of ALS although I do have my down days.
    I'm singing and dancing inside!

  2. #2
    Forum Member jadedjohn's Avatar
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    Thanks for posting this - i was put off having one before seeing this - i definatly not now!

    john
    http://www.jaded-john.net

    First onset Oct 2009, Dx'ed Oct 2010 at the age of 42

  3. #3
    Forum Member Jeannie's Avatar
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    Bump
    Best wishes

    Jeannie

    Please donate and share forever grateful xx Please see the link https://www.gofundme.com/83tq5j-help..._co_campmgmt_w
    ______________________________________
    ALS onset June 2000, dxed July 2001, I am 40 yrs old.
    Living and loving everyday regardless of ALS although I do have my down days.
    I'm singing and dancing inside!

  4. #4
    Forum Member computatec's Avatar
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    I'm with you on this John. The more I learn about it the more I shun the idea. What Jeannie has shown us is only half of the story because there is a lot of hassle getting the feeding right so you don't screw up your bowel function.

    Clive
    Living with MND. There is a solution to every problem - never ever give up.

  5. #5
    Forum Member john's Avatar
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    Clive,
    I am a care giver to my wife Irene who until June this year was really struggling with food. Meals took 2 hours to consume, drinks were an increasing difficulty and she was losing weight fast. She had a peg fitted 22nd June and had a couple of days in hospital to make sure everything worked as it should and she could tolerate the food. Since then she has not had a problem other than the bowels which you mentioned and movements have gradually become less frequent. The dietician has varied the feed to one containing some fibre( the original had none!!) and we await the outcome. She has regained her former weight and she is a lot happier without the 2hour meals but that could be down to my cooking.

    John

  6. #6
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    My husband is now due to have one fitted and now I'm worried! I though that the op was routine and not horrendous?! Any positive stories?

    I thought it was better to have one fitted earlier rather than later?

    Tracy

  7. #7
    Forum Member john's Avatar
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    Hi Tracy,

    Irene's op was a piece of cake -- easy for me to say. She was in and out in half an hour or so and conscious throughout with just a liitle anaesthesia for her throat to relax. Came out smiling with no blood or pain. Healed pretty quickly and has certainly taken the anxiety of eating and drinking and choking out of her life. I've not her any complaints from her about it at all. I'm sure he won't regret it for a moment.

    John

  8. #8
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    Thanks John, feel bit better now!

  9. #9
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    Hi - the one mistake we made with Carol's progression was not getting the PEG fitted early enough. We delayed a couple of possible appointments because Carol wasn't sure until eventually feeding was almost impossible and it was done in a rush.
    The op was simple and Carol had no problems adapting to the feeding regime - it's time consuming (a 1 litre bag takes 10 hours) and we've played around with types of feed / supplements / times etc in the 12 months since it's been fitted.
    Feeding through the night was our early choice but it eventually affected Carol's sleep so we switched to days.
    For Carol the PEG also gives much better control of fluid and medication intake - in the end it was a necessity but it's the solution we needed to counter the loss of Carol's ability to swallow any types of food or drink.
    All the best

  10. #10
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    Hi All
    I have read this information with great interest because my mum is going to have a peg fitted in March. What worries me is that her swallowing is extremelly poor and we have had numerous coughing and choking episodes so how did you and yours tollerate the endoscope?Otherwise i am glad she is having the peg fitted as I think it will improve her quality of life greatly. Any info would be great thanks.
    Kate xx

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